A TEXT-BOOK 



OF 



MATERIA MEDICA. 



THERAPEUTICS. AND PHARMACOLOGY. 



BY 

GEORGE FRANK BUTLER, Ph.G., M.D., 

Professor of Materia Medica and Therapeutics in the College of Physicians and Surgeons, Chicago, 

Medical Department of the University of Illinois ; Medical Superintendent of Alma Sanitarium, 

Alma, Michigan ; Member of the American Medical Association, Illinois State Medical 

Society, Chicago Medical Society, Chicago Pathological Society, and Chicago Society 

of Internal Medicine ; Fellow of the Chicago Academy of Medicine, etc. 



jfouttb E&ition, TTborougblE IRevisefc. 



Miseris succurrere disco. 



PHILADELPHIA AND LONDON 

W. B. SAUNDERS & COMPANY 

1902 



THlTLlBRAffY OF 
CONGRESS, 

Two Corks Received 

2 1902 

Copyright entry 

C'.AS§^XXo. No. 

COf»Y B. 






*.*y 



Copyright, 1902, 
By W. B. SAUNDERS & COMPANY. 



ELEOTROTYPEO BY 
WE3TCOTT & THOMSON, PHILAOA. 



PRESS OF 
SAUNDERS &. COMPAr> 



TO 



THE MEDICAL STUDENTS OF THE UNITED STATES, 

IN THE HOPE THAT IT MAY AID THEM IN ATTAINING A CORRECT 

KNOWLEDGE OF THE NATURE AND ACTION OF DRUGS 

AND THE RATIONAL TREATMENT OF DISEASE, 

THIS WORK IS CORDIALLY INSCRIBED BT 

THE AUTHOR. 



PREFACE TO THE FOURTH EDITION. 



The following important alterations and additions have been 
made in this edition, namely : a thorough remodeling of the open- 
ing chapters, to bring them into accord with recently discovered 
biological phenomena and natural interpretation of the disease 
process as reactive and self-preservative. 

The pharmacology and therapeutics of each drug have been 
carefully revised, incorporating all the recent advances that have 
been made in pharmacodynamics. 

Numerous changes have been made in the expressions of 
opinion regarding the utility of certain drugs, notably the newer 
synthetics, which larger experience has modified, resulting in more 
definite conclusions. Many of them have been introduced, their 
actions discussed, and their therapeutic uses fully expounded, 
while considerable attention has been paid to their incompatibles. 

The chapters on Organotherapy, Serum-therapy, and cognate 
subjects have been enlarged and carefully revised. 

Perhaps the most important addition is the chapter devoted to 
the interesting phases of the newer theories of electrolytic disso- 
ciation and its relations to the topic of pharmacotherapy, and the 
relevant discussion added of the simpler relations of chemical 
structure to drug-action. 

The author desires to express his sincere acknowledgment to Dr. 
Smith Ely Jelliffe, of New York City, for his valuable assistance in 
the revision of the work, and to Dr. Martin H. Fisher, Associate in 
Physiology in the University of Chicago, for his interesting con- 
tribution, " The Relation of Physical Chemistry to Pharmacology 
and Therapeutics." 

GEORGE FRANK BUTLER. 
Alma, Mich., August, 1902. 

9 



PREFACE 



The present work has been undertaken with the immediate 
object of supplying the student of medicine with a clear, concise, 
and practical text-book, adapted for permanent reference no less 
than for the requirements of the class-room. 

The arrangement — embodying the synthetic classification of 
drugs based upon therapeutic affinities — the author believes to be 
at once the most philosophical and rational, as well as that best 
calculated to engage the interest of those to whom the academic 
study of the subject is wont to offer no little perplexity. 

Should an intelligent and comprehensive understanding of 
Materia Medica and Therapeutics be facilitated by the author's 
treatment of the theme, the deductions derived from his experience 
as a practitioner and instructor will not have been committed to 
print in vain. 

Special attention has been given to the Pharmaceutical section, 
which there is reason to hope will be found exceptionally lucid 
and complete. It has been deemed advisable, however, in the 
general work to include in the descriptive enumeration only such 
drugs as experience has proved to be of unquestionable value 
and are of standard and authoritative acceptance in general prac- 
tice. In accordance with this plan, many new and comparatively 
untried remedies have been omitted, since, while of established 
efficacy in certain conditions, they are as yet too imperfectly known 
to warrant association with remedial agents bearing the sanction 
of exhaustive scrutiny. So, too, a few official drugs have been 
excluded because they are practically never used or are employed 
only in isolated instances. 

It will be observed that "Untoward Action" and "Poisoning" 

11 



12 PREFACE. 

are treated under separate heads. By the former it is intended to 
record the effects of medicinal doses in developing certain symp- 
toms dependent more or less upon individual susceptibility, not 
necessarily assuming the aggravated form incident to toxic doses, 
which exert a definite influence regardless of idiosyncrasy. 

In giving the careful Latin accent and quantity of medicinal 
nomenclature (Foster), so far as practicable with the prosodial 
signs employed, the design has been to correct a prevalent dis- 
regard of proper pronunciation reflecting little credit upon those 
to whom a knowledge of the subject should be as exact as it is 
familiar. To the prescription-writer the appropriate Latin genitive, 
and in a few cases the accusative, will doubtless afford valuable 
assistance. 

During the preparation of the work many important text- 
books, periodicals, etc. have been freely consulted, and from the 
U. S. Pharmacopceia chiefly, and from the National Dispensatory, 
have been adopted almost verbatim the "Origin" and "Description 
and Properties " of the various drugs under consideration. 

In reviewing the progress of the present volume the author 
desires to express his cordial acknowledgments to Prof. Carl S. N. 
Hallberg, Ph. G., whose exhaustive contribution of "Weights and 
Measures" and "Pharmaceutical Preparations" cannot fail to 
lend permanent interest to the work ; to Dr. Alfred C. Cotton, Dr. 
Wm. E. Quine, and Dr. James B. Herrick, for friendly suggestions ; 
to Dr. D. Lee Shaw, Dr. Fred C. ZapfTe, and Dr. Thomas J. Jack- 
son, for assistance in compilation. To Mr. Storrow Higginson the 
author's personal thanks are due for his scholarly assistance in 
the revision of the text. 

G. F. B. 

Chicago, III., 794 West Adams St., 
September, 1896. 



CONTENTS 



C AGB 

INTRODUCTION 17 

PHARMACOLOGY AND GENERAL THERAPEUTICS 21 

Classification of Medicines 32 

Administration of Remedies 37 

Untoward Effects of Drugs 45 

Weights and Measures 54 

PHARMACEUTICAL PREPARATIONS 62 

Solutions 62 

Aquae Medicatae — Medicated Waters 64 

Liquores — Solutions 64 

Spiritus — Spirits 7° 

Syrupi — Syrups 7 l 

Elixiria — Elixirs 77 

Glycerita — Glycerites 84 

Liquid Mixtures — Internal 85 

Misturae — Mixtures 85 

Emulsa — Emulsions 89 

Extractive Preparations 9 2 

Infusa — Infusions , 94 

Decocta — Decoctions 95 

Aceta — Vinegars 95 

Vina — Wines 95 

Tincturae — Tinctures 97 

Extracta Fluida — Fluid Extracts 103 

Extracta— Extracts 10S 

Abstracta — Abstracts 109 

Oleoresinae — Oleoresins no 

Resinae — Resins H I 

Solid Mixtures for Internal Use 112 

Pulveres — Powders , 113 

Sales Effervescentes — Effervescent Salts 116 

Confectiones — Confections 117 

Trochisci — Troches 118 

Massae — Masses 119 

Pilulae— Pills 120 

Unofficial Forms of Mixtures of Solids for Internal Use 125 

Preparations for External Use 1:6 

Linimenta — Liniments 127 

Lotiones — Washes l2 $ 

Oleata— Oleates c .129 

Olea Infusa — Infused Oils l 3° 

Collodia — Collodions '3° 

13 



14 CONTENTS. 

PAGE 

Unguenta — Ointments 131 

Cerata — Cerates 133 

Suppositoria — Suppositories 134 

Emplastra — Plasters 135 

Chartse — Papers , = . 137 

Poultice or Cataplasm - 138 

Fomentations 138 

Spongiopiline 138 

Plaster Mull 138 

Caustics or Escharotics 138 

Bandages, Antiseptic Dressings 138 

Medicated Dressings 139 

Medicated Cottons 139 

Medicated Gauzes — Carbasa . 139 

Plaster-of-Paris Bandages 140 

CLASS I.— DISEASE MEDICINES 141 

Division I. — Restoratives 141 

Group I. — Digestants 141 

Group II. — Fats and Oils 145 

Group III. — Mineral Acids - . 149 

Group IV. — Organic Acids 157 

Group V. — Alkalies 162 

Group VI. — Mineral Waters 178 

Group VII. — Bitters 183 

Simple Bitters 183 

Aromatic Bitters 185 

Group VIII. — Hematics 192 

Animal Extracts (Organo-therapy) 231 

Division II. — Alteratives 239 

Serum-therapy 287 

Division III. — Antiseptics ; . 323 

Aromatics 377 

CLASS II.— SYMPTOM MEDICINES 399 

Group I. — Antispasmodics 399 

Group IT. — Antipyretics 407 

Group III.— Anesthetics 4 l8 

Group IV.— Hypnotics 434 

Group V. — Narcotics ; 45 2 

Group VI.— Motor Excitants 489 

Group VII.— Motor Depressants 524 

Bromides 553 

Group VIII.— Cardiac Stimulants 561 

Group IX.— Cardiac Sedatives 602 

Group X. — Diaphoretics 618 

Group XL— Emetics 625 

Group XII. — Expectorants 640 

Group XIII.— Diuretics 654 



CONTENTS. 15 

PAGE 

Group XIV.— Cathartics 683 

Laxatives 690 

Simple Purgatives 698 

Hydragogue Purgatives 708 

Salines 712 

Drastic Purgatives 715 

Group XV. — Anthelmintics 719 

Group XVI. — Emmenagogues and Ecbolics 728 

Group XVII. — Astringents 734 

Vegetable Astringents 735 

Mineral Astringents , 750 

TOPICAL REMEDIES. 

Group XVIII. — Rubefacients 783 

Group XIX. — Vesicants and Epispastics 785 

Group XX. — Caustics or Escharotics 793 

Group XXI. — Emollients, Demulcents, and Protective Agents . . . 800 

PRESCRIPTIONS 811 

THE RELATION OF PHYSICAL CHEMISTRY TO PHARMACOLOGY 

AND THERAPEUTICS 840 



GENERAL INDEX 849 

CLINICAL INDEX 871 



A TEXT-BOOK 

OF 

MATERIA MEDICA, 

PHARMACOLOGY, AND THERAPEUTICS, 



INTRODUCTION. 



The history of medicine since the time of Hippocrates is the 
record of a more or less continuous series of experimental re- 
searches, having for their paramount object a precise and compre- 
hensive knowledge of the nature of disease and the practical 
application of remedial science. Regarded sensu latiori, the 
various " schools " which have arisen from time to time are 
philosophically co-ordinate, their fundamental principles being ref- 
erable to one dominating thought — the art of healing. 

It is scarcely practicable here, even were it necessary, to review 
in detail the separate doctrines which have obtained during the 
evolution of sectarian therapy. From the earliest ideas promul- 
gated by the ancient priests of ^Esculapius, through the subse- 
quent era of Hippocrates, Theophrastus, and the Alexandrian 
school, influenced by the crude, misguided notions prevailing ere 
science emerged from its infancy ; discernible in the Galenic and 
other tentative yet memorable systems, in the epoch of Paracelsus 
and the Monastic Medicine of the Mediaeval period, and in the 
radical theories of Rasori and Roeschlaub which attended the 
development of the eighteenth and have left a passing impress upon 
the nineteenth century, — through all, the gradual acceptance of 
empiricism as a legitimate guide to therapeutic truth is manifest. 
Yet viewed with reference to their underlying animus, these varied 
expressions of scientific endeavor distinguishing the part are per- 
ceptibly linked with the ampler system which has emanated from 
the more rational methods of modern research. 

2 17 



18 A TEXT-BOOK OF MATERIA MEDICA. 

The light of inductive reasoning and the marvellous progress in 
scientific knowledge which characterize the nineteenth century are 
a living appeal from the idealism of a less enlightened age. The 
release from tradition — anticipated in the labors of Bichat and 
others — to which later investigation owes so many signal triumphs 
has doubtless been profoundly affected by the realistic tendency of 
modern thought. It is to the startling advancement attained in the 
natural sciences, however, resulting in a chemical skill and in me- 
chanical appliances of incomparable value, that we must look for 
the originating impulse which has inspired the therapeutic know- 
ledge of the present day. It needs but little reflection to perceive 
the immeasurable superiority of actual acquirements over the vague, 
hesitating — though ardent and laborious — methods to which the 
theory and practice of medicine were so long subservient. 

We have said that, considered in the larger sense, the history of 
medicine has been a harmonious rather than an intermittent devel- 
opment. It is not to be supposed that, in the evolution of so 
momentous a scheme as the formulation of a remedial system 
applicable to the extensive catalogue of human ailments, there 
should not have occurred spasmodic and ill-adjusted theories, 
crystallizing in many a strange cultus, which, if ineffectual in 
retarding the onward sweep of rational progress, has, it may be 
safely averred, worked incalculable injury to the cause of medical 
truth. Mesmerism, astrology, spiritualism, even theosophy, how- 
ever incongruously conjoined, and similar vagaries have not failed 
to enlist among their votaries many enraptured, even noted, be- 
lievers ; nor is the mental strabismus with which they are afflicted 
amenable to any resource of rational treatment. We need, more- 
over, but contemplate the pitiable hallucinations which urge the 
pious pilgrimages to Marpingen, Lourdes, and Treves, and the 
criminal negligence and incredible offence to reason which stultify 
the so-called " Christian Scientists " (as ironical a misnomer as Ian- 
guage permits), to realize that miraculous cures still hold blighting 
yet potent sway over the minds of the ignorant and credulous. 
May not even the assumption of thaumaturgical powers be one 
day possible with those who arrogate to themselves a knowledge 
little short of omniscience, and to whose rudimentary intelligence 
the laws of nature convey no perceptible lesson ? As from the 
sublime to the ridiculous, so from faith to fanaticism, it is but a 
step, after all. 

It is appropriate here to emphasize the unfailing — nay, ever- 



INTRODUCTION. 19 

increasing — importance of therapeutics in its relation to the wel- 
fare of mankind. Especially imperative is this obligation in an 
epoch of unprecedented achievement in every department of science 
which contributes to the perfection of the healing art, in which 
general advancement medicine has borne no inconspicuous role. 

The rapid advance of experimental science, however, applied 
to medical treatment, culminating in bacteriological discoveries of 
signal value to mankind, and the remarkable triumphs attending 
the development of operative surgery, have inevitably tended to 
disparage the equally noble and far more widely cultivated field of 
therapeutic science. This result is the more deplorable since it 
creates in the minds of the young and inexperienced an impression 
of contrast and divergence in departments of study naturally and 
indissolubly correlated. It is scarcely surprising that the marvels 
of the laboratory and the splendid achievements of the arena should 
possess for the tyro an entrancing interest. Yet it is to be borne in 
mind that the most brilliant triumphs of diagnostic and surgical 
skill might prove futile as the means of arresting disease were they 
not supplemented by the course of treatment which constitutes 
therapy. 

It must be confessed that medical art has too often been dis- 
credited by professional incompetence, and consequent failure to 
effect the cure which with the laity is wont to form, however ignor- 
antly, the only criterion of ability. In America especially — where 
from defective laws the widest latitude is given to incapacity and 
imposture — the lack of proper academical training is frequently 
the cause of serious consequences in practice, little calculated to 
enhance the popular confidence and esteem. It therefore behooves 
the student of medicine to master thoroughly the details of the 
remedial art, become practically conversant with physiological 
conditions and the manifold phenomena of morbid anatomy, and 
so familiarize himself with the varying indications of disease that 
in the presence of whatever malady, his diagnosis and treatment 
may command respect — not only from the laity, but, what is of far 
more consequence to him, from the profession. 

It is almost superfluous to lay stress upon pharmaceutical know- 
ledge as a powerful weapon in the armament of the medical prac- 
titioner. Yet no branch of therapeutic science has, perhaps, been 
more neglected than a practical acquaintance with the nature and 
uses of Materia Medica, their origin, potency, and characteristic 
value, as well as their physiological action, and the incompatible 



20 A TEXT-BOOK OF MATERIA MEDICA. 

and synergistic agents upon which their efficacy often largely 
depends. 

Thanks to careful and competent training among pharmacists, 
the skilful preparation and dispensing of drugs relieve the physi- 
cian of much responsibility ; yet he should be keenly sensible of 
the fact that the larger share of public confidence is reposed in 
him, and by diligent study of the subject endeavor to command 
the minutiae of pharmacology, holding himself morally accountable 
for errors quite possible in the druggist's dispensary. It may not 
be irrelevant to add that in all medical procedure a sympathetic 
yet perfectly controlled nature, ready tact, and sterling common 
sense are cardinal requisites to professional triumph, it being gene- 
rally true, as was long since observed by Hufeland, that " success- 
ful treatment requires only one-third science and two-thirds savoir 
faire" 

Finally, the author would counsel the utmost seriousness in 
the pursuit of a calling which might aptly be termed " Christian 
Science" — the power to alleviate human suffering by means of 
curative agents with which the laboratory of nature has been 
mercifully stored. There can be no loftier, more practical mani- 
festation of love to men than is exemplified in the benignant effort 
to assuage the ills to which mortality is heir ; nor can any devotion 
be more privileged and inspiring than that which softens the shock 
of disease, illumines the darkness of mental and physical distress, 
and from the debris of misfortune, vice, and heredity creates anew 
the image of divine perfection. It is this uplifting, consecrated 
zeal, akin to veneration for medical science, which has endeared to 
the world the masters of the profession — of which the same wise 
Hufeland said : " To him who fails to make a religion of the heal- 
ing art it is the most cheerless, wearisome, and thankless labor 
upon earth ; indeed, in him it must become the greatest frivolity 
and a sin." And for those — and they are many — to whom the 
material, possibly mercenary, aspect of their task appeals unduly 
it is enough to cite in rebuke the elevated maxim of Stigelius ■ 

Non omnia quae suscipimus lucrum spectant. 
[ Thunbergii Dissertationes. ] 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 



Nature heals, physicians treat — is a truth of old that is con- 
stantly forgotten : always by the patient, who expects the patent 
medicine or the family doctor to cure her ; frequently by the 
physician, who is often persuaded, against his better judgment, to 
believe in the supernatural when the mysteries of drug action are 
involved. A few propositions concerning the general action of the 
human body in its endeavor to cure itself may not be out of place 
in an introduction to a work on the practice and art of aiding 
nature's forces in the treatment of abnormal conditions. 

It is a difficult task to express, in a few phrases, the general 
causes of disease, but the following general agencies may be con- 
sidered : 

1. Trauma, whether the result purely of accident, or brought 
about in the general struggle for existence. 

2. Parasites, both microscopical and macroscopical, acting within 
and without the body. 

3. Poisoning from plants and animals, broken down and decom- 
posed food-stuffs, and poisonous gases taken into the respiratory 
tract. 

4. Bad hygiene, unwise modes of living, including faulty nutri- 
tion, faulty modes of dress, eating, and housing, use or abuse of 
certain organs or their lack of use. 

5. Heredity. — Here would be classified not only the directly 
transmissible diseases, as syphilis, but also those constitutional 
dyscrasiae that conduce to premature break-down of some part of 
the human body. 

In order to combat these various agencies the individual organs 
have developed a system of natural cure methods (" natural thera- 
peutics ") that are of interest. These may be summarized briefly, 
following Kobert, in part, as : 

1. Healing by regeneration. Among the lower animals the 
regeneration of a lost member is not infrequent, but in man it is 
unusual. In a sense, however, the healing of wounds as a part of 

21 



22 A TEXT-BOOK OF MATERIA MEDICA. 

the inflammatory reaction is analogous to this process in the lower 
animals. The hypertrophy of one kidney, compensating for the 
loss of the other, and the establishment of a collateral circulation 
are illustrations of what Bachmann, in 1894, pointed out as the 
law of equivalent compensations. 

2. Healing may be brought about by the exercise of an organ. 
Thus, the old-fashioned system of exposure to wet and weather 
develops, by exercise of the skin, an increased resistance to agencies 
that otherwise might react harmfully on the organism. 

3. In the struggle against parasites it would appear that the 
body had developed an extensive array of protective agencies. 
Thus, antiseptic substances in the saliva, gastric juice, and bile are 
simple instances of this protective power against parasites from the 
outside. The doctrine of phagocytosis embodies the principle of 
the action of the white blood-cell in its office as a protective agent. 
In the body-fluids are found alexins, antitoxins, immunizing pro- 
teids that protect from the actions of poisons which may develop 
as a result of the life activities of these parasites should they obtain 
a foot-hold within the body — or even protect from poisons devel- 
oped in the course of disturbed metabolism. Fever, so frequently 
regarded as an adverse sign in disease, undoubtedly serves in large 
part as a means of protection of the body — by killing the agents 
that have induced the rise in temperature. 

4. Healing from certain poisons is brought about by vomiting 
and diarrhea, by rapid elimination through diuresis, or by excessive 
perspiration. Within the body a most interesting series of changes 
often takes place — thus, splitting up of poisons, their oxidation or 
conversion, or even fixation, into non-toxic products is a constant 
phenomenon. Thus even so powerful an alkaloid as morphine is 
said by Faust to be in part oxidized and perhaps used as a food- 
stuff. The chemical changes that take place in the liver have here 
their most potent activities, and the pathological chemistry of the 
twentieth century promises to throw much light on these compli- 
cated problems. Poisons also are compensated for by the process 
of adaptation (habituation), and are frequently rendered inert by 
the development of specific antitoxic substances. Thus specific 
anti-morphine bodies have been developed in the blood of some of 
the lower animals. 

5. The physiologicalprocess of rest is an expression of nature 
healing. Loss of appetite is the indication not to eat. Pain calls 
for rest. 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 23 

6. Healing by the casting off of a portion of the organism is a 
process of nature healing widely made use of in diseases among 
plants and the lower animals. Abscess formation, the limiting, by 
fibrinous exudates, of intraperitoneal irritants, and spontaneous 
gangrene of the extremities are well- recognized examples of such 
a type of nature's healing. 

Treatment is something apart from healing, and in its broad 
sense comprises all those means, psychical or physical, which the 
practiser of the healing art has at his command by which he can 
hope to alter an abnormal condition in the individual he is called 
on to treat. Thus, nature calls into play the highest of her gifts, 
intelligence, to aid her in the work of self-preservation, and it is 
the function of the text-book to aid, in so far as it is able, to train 
that intelligence in the facts that experience has proved of value — 
in the present instance, in the fields of materia medica, pharmaco- 
dynamics, and therapeutics. 

Pharmacology, from the broad point of view, is the science 
of drugs, and includes the various fields of medical botany, med- 
ical zoology, pharmacognosy, pharmacodynamics, and pharmacy. 
Within recent years, however, following the German school, its 
meaning has been restricted and made equivalent to pharmaco- 
dynamics, or the study of the effects of physical or chemical 
agencies on living organisms. It is in this sense that it is used in 
this work. 

Materia Medica is the study of the materials, organic and 
inorganic, used for drugs in their physical and chemical characters. 

Pharmacognosy is a division of materia medica, and includes 
the technical study of the crude materials from which drugs are 
derived. Its deliberation is limited to the animal and the vegetable 
kingdoms, but it is not a science with sharply defined boundaries, as 
it encroaches on so many avenues of knowledge — systematic bot- 
any, zoology, gross and minute anatomy, chemistry, and pharmacy. 

Pharmacy is largely a chemical study. It deals with those 
manipulations by which the potent principles of drugs are rendered 
available for therapeutic purposes. 

Therapeutics is the art and practice of treating abnormal bodily 
states. It has for its object the restitution to the normal, or, if 
such is impossible, the giving of comparative comfort to the invalid. 
Its range of activity, therefore, is extremely wide, and a combina- 
tion of methods is necessary to the resourceful physician. The 
following general modes of treatment should be considered : 



24 A TEXT-BOOK OF MATERIA MEDIC A. 

Suggestion Therapy. — --Faith is one of the oldest therapeutic 
agencies of which anything is known. As Dr. Osier 1 has so well 
said, " Faith in the Gods or in the Saints cures one, faith in little 
pills another, hypnotic suggestion a third, faith in a plain common 
doctor a fourth. In all ages the prayer of faith has healed the 
sick, and the mental attitude of the suppliant seems to be of more 
consequence than the powers to which the prayer is addressed. 
The cures in the temples of ^Esculapius, the miracles of the Saints, 
the remarkable cures of those noble men, the Jesuit missionaries, 
in this country, the modern miracles of Lourdes, and the wonder- 
workings of the so-called Christian Scientists are often genuine and 
must be considered in discussing the foundations of therapeutics." 
" Physicians use the same power every day. If a poor lass, par- 
alyzed, apparently helpless, bed-ridden for years, comes to me, 
having worn out in mind, body, and estate a devoted family, and 
she in a few weeks or less by faith in me, and faith alone, takes up 
her bed and walks, the saints of old could not have done more." 
" The faith with which we work, the faith, indeed, which is available 
to-day in every-day life, has its limitations : it will not raise the 
dead : it will not put in a new eye in place of a bad one, nor will 
it cure cancer or pneumonia or knit a bone ; but in spite of the 
nineteenth century restrictions, such as we find it, faith is a most 
precious commodity without which we should be very badly off." 

Of the various forms of suggestive treatment it is not necessary 
here to treat. One form, treatment by hypnosis, is worthy of 
careful study, but its details are out of place here. 

Heliotherapy, exposure to the rays of the sun, or, in Finsen's 
latest developments, to the activities of the x-rays ; aerotherapy, 
or exposure to the open air, moist air, dry air, superheated air, etc. 
— both constitute modes of treating some forms of disease. Much 
might be said of Climato therapy, the principles of which are not 
well understood. Dietetic Therapy. — This is also a method of 
antiquity. Diet — milk cures, vegetarian diet, meat diets, diets for 
obesity, for diabetes, etc. — has extreme practical importance, and 
its principles should be thoroughly mastered by the student. 

Physicomechanical Therapy. — This includes a large number 
of useful procedures — Kinesotherapy, or massage and Swedish 
movements, from which the fantastical osteopathy has developed, 
is one of the most important. The Chinese and Japanese have 
used massage for a thousand years, and it constitutes one of their 

1 Medicine of the Nineteenth Century, 1901. 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 25 

most important therapeutic procedures. Tissot, in 1780, brought 
the methods in use once more in Europe; Schebe, of Germany, in 
1847, an d Zander, of Stockholm, in 1865, brought the modern 
gymnastic procedures to a state of perfection. 

Hydrotherapy, involving the use of heat and cold, with modi- 
fied massage, has justly become a most important therapeutic pro- 
cedure. E. F. C. Oertel, of Bayreuth, in 1765, and Preissnitz, in 
1790, may be regarded as the founders of modern hydrotherapy. 
Its most useful applications are to be found in reducing tempera- 
ture, in promoting sleep, and in neurasthenic and weakened nervous 
states, although its applications in one form or another are numerous. 
Tonsillitis, pharyngitis, conjunctivitis, abdominal pain, ovarian neu- 
ralgias, etc., are all benefited by hot applications. 

Hypodermoclysis and enteroclysis are special forms of hydro- 
therapy which are of great value. 

Electrotherapy. — Electricity is a potent agent in the treatment 
of certain forms of disease. Within recent years more definite ideas 
have been gained regarding the mode of its action. Space does 
not permit of more than an indication of the merest outlines in this 
place, the student being referred to text-books on the subject 
(Jacoby, " Electrotherapeutics "). 

In general, two types of current, galvanic and faradic, are 
employed both for diagnostic and for therapeutic purposes. The 
galvanic current is of constant flow, low intensity, and small in 
quantity. It has little influence in causing muscular contractions, 
but has marked chemical and thermal properties and promotes 
metabolism. The faradic current consists of alternating to-and-fro 
currents, is usually of high intensity, and has marked power to 
promote muscle contractility. The knowledge of the different 
modes of application should be gained from a good text-book. 

In using electricity for diagnostic purposes it is advisable to use 
the minimum amount of current to produce a desired effect. The 
two sides of the body should be carefully compared, and the 
patient should be at rest. It is advisable to have similar electrodes, 
and they should be applied to corresponding areas on the well side 
and the supposedly diseased side. 

The condition of muscular contractility is investigated in using 
the galvanic current by making and breaking the current. Under 
the influence of small to medium currents the normal reaction 
of a muscle should be that the anodal clos?ire contraction is less 
than the cathodal closure contraction, thus, A.C.C. < C.C.C. In a 



26 A TEXT-BOOK OF MATERIA MEDIC A. 

muscle that is just beginning to show signs of a loss of muscular 
contractility the A.C.C = C.C.C., whereas if the anodal closure con- 
traction is greater than the cathodal closure contraction the reaction 
is known as the reaction of degeneration, and is an evidence of dis- 
ease. Reaction of degeneration must result from almost any 
extensive lesion of the peripheral motor neuron. It is found in 
extensive neuritis from toxic causes, alcohol, lead, zinc, carbon 
disulphide, mercury, malarial poisoning, etc., in acute anterior 
poliomyelitis or other disease involving the cells in the anterior 
horns of the cord ; it may also occur with extensive muscle disease. 

From a therapeutic point of view electricity is having a con- 
stantly widening application. The use of the x-rays in lupus and 
in flat epitheliomata is as certain as it is marvellous, and the appli- 
cation of the Finsen phototherapy is but in its infancy. Electricity 
is widely employed as an irritant, caustic, and escharotic. In 
paralyses of spinal and neuritic origin its properties of stimulating 
metabolism make it a highly desirable therapeutic measure. When 
combined with massage and infinite pains and tact, continued for 
long periods of time, seemingly hopeless paralyses may be very 
markedly relieved. Eternal persistency is sometimes the price of 
recovery. In sensory affections the static current often is of ser- 
vice. Mental suggestibility is here an important item, and the 
static machine lends itself very readily to much quackery. Galvan- 
ism is often very useful in relieving the deep-seated pains of sciatica 
and lumbago. By many, electricity is deemed of no value, and by 
others as a panacea for all ills. The truth lies in the means. In 
proper hands it is an exceedingly useful agent, but it has fallen 
very much in the estimation of the profession because of the 
great use made of electricity by the charlatan and professional 
parasites on that portion of society that so delights in being hum- 
bugged. 

Toxicology. — Pharmacology and toxicology are in a sense the 
same. They represent quantitative variation only. All pharma- 
cological action represents some variation from normal standards. 
When such variations reach a point where the disturbance of func- 
tion threatens to be or is fraught with danger to the well-being or 
life of the organism, then the subject is suffering from the toxic 
action of such an agent. 

Pharmacotherapy .—This includes the study of remedial agents 
proper or the use of drug substances. It considers the applica- 
tions of the teachings of pharmacology to the treatment of abnormal 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 2 J 

body states. It naturally constitutes the most important branch 
of therapeutics. 

It is not to be supposed that our present elaborate systems of 
pharmacotherapy have come into existence as they now are found. 
They have had a natural development, and the various methods 
have merged, the one into another. Certain arbitrary methods 
have received special names, such as Empirical, Specific, Statistical, 
Physiological, Rational Therapeutics, etc. 

Empirical Therapeutics implies the application of remedies to 
which experience has ascribed certain specific properties irre- 
spective of systematic value. It is not based upon experimental 
research, but rather upon formulae established by the accumula- 
tion of isolated facts — empiricism — and practical observation, apart 
from theoretical reasoning and the relations of physiological phe- 
nomena as revealed by modern methods of investigation. Were 
it possible to extend indefinitely the list of remedial agents so as 
to embrace the entire field of therapeutic knowledge, the empirical 
method might attain the dignity of an exact science. Such, how- 
ever, is the complexity arising from the manifold, often contra- 
dictory, impressions drawn from human experience that for the 
evolution of a systematic scheme of therapeutics the empirical 
system must of necessity prove inadequate. 

By Specific Therapeutics is meant a system of treatment that 
implies that certain diseases have certain definite antidotes. Thus, 
mercury and the iodides are specifics for syphilis, antitoxin for 
diphtheria, antivenin for snake-bite, etc. 

Statistical Therapeutics implies a method of treatment that is 
the outcome of the experience of the results observed in a large 
number of cases under certain restricted lines of treatment. This 
method arrives at excellent results if sufficient numbers of cases of 
the same type can be observed, but disease processes vary so 
widely in different individuals that the statistical method alone is 
not unlikely to lead to error. 

Physiological Therapeutics consists in the application of the 
strict interpretations of the pharmacodynamic action of drugs to 
diseased conditions. With increasing knowledge its principles will 
prove more and more applicable, but the inherent difficulties of 
interpretation of all biological phenomena will always make this 
method unsatisfying. 

On the General Action of Drugs. — Broadly speaking, the action 
of drugs is exerted either locally or systemically, whereas the 



28 A TEXT-BOOK OF MA TERIA MEDICA. 

effects which are known as reflex action occupy a middle ground 
between the two. Many drugs have only a limited action at the 
point of application, while others possess not only a local, but a 
systemic, action as well. 

The action of drugs is fundamentally a question of protoplasm 
chemistry, but the investigations of the biologist have not yet 
reduced the interpretations of nature to a question of molecular 
physics ; until they do, pharmacology will retain the words irrita- 
tion, stimulation, depression, paralysis, and death of protoplasm. 
Hueppe, in 1891, enunciated the doctrine that all remedies first, in 
small doses, produced an irritant and stimulating action in proto- 
plasm, to be followed, when used in larger doses, by a depressing 
or paralyzing action, which might go on to death of the protoplasm 
acted on. Thus the effects of small and large doses were con- 
trasted ; the foundations of the homeopathic idea are closely related 
to this interesting phenomenon. It is not a universal phenomenon, 
however, and cannot be designated as a law, as Hueppe claimed. 
There are a large number of substances that in small and large 
doses have antagonistic effects, but the antagonism is by no means 
an equal one. Thus is it a familiar illustration that small doses of 
morphine increase mental activity by slight stimulation, whereas 
large doses depress and paralyze and bring about unconsciousness. 
The grade of excitement cannot at all be made commensurate with 
the grade of depression by making the doses smaller and smaller. 
Chloral acts as an irritant to the peripheral nerve-endings, although 
it depresses and paralyzes the central nervous system. Citations 
might be multiplied to show the host of inconsistencies and varia- 
tions. 

If such variations are found to be true for the action of drugs 
on the normal human body, how much more variable are the 
results of pharmacotherapy on the diseased organism. At times a 
given agent acts with less force on a diseased organ than on a 
healthy one ; at times again with greater activity, and still further 
the action of a drug may be diametrically opposed in health and 
in disease. 

At the present time the limits of present-day information offer 
but little hope for a better interpretation of these questions, and 
not only is the clinical side of the problem obscure, but the chemi- 
cal side is equally uncertainl It seems that different chemical 
actions must be considered. Many compounds seem to react on 
protoplasm with a mutual disarrangement of the molecules ; thus 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 2Q 

the action of strychnine is interpreted ; others act on the tissues 
and are eliminated unchanged, and yet have probably altered the 
chemical character of the tissues acted on. Of late years, through 
the studies of followers of Nernst and Ostvvald, an entirely new 
series of studies have been carried on which are destined to be 
closely related to the study of the physiological action of drugs. 
The study of electrolytic dissociation has already opened up new 
fields in physiology, and the ground is being broken in pharma- 
cology. In the salts of the alkalies are found a series of actions 
differing from those already spoken of; here the active agent 
induces changes in the watery content of the protoplasm or in the 
water of the liquids surrounding the cells, and brings about a 
series of physical, rather than chemical, changes. The familiar 
experiments of plasmolysis in the botanical laboratories illustrate 
this action, which is controlled by the general laws of diffusion of 
liquids, which are separated by animal or vegetable membranes. 

In the animal body many salts are found in solution, not as 
complete molecules, but as made up of their electrical components, 
or ions, one positive and another negative, and when a chemical 
action takes place, it is an action not between the molecules of the 
salt and the protoplasm, but between an ion of the salt and the 
protoplasm, or even ions of the protoplasm molecule. For many 
of the simpler inorganic compounds, NaCl, KC1, KBr, KI, K(OH), 
many metallic salts, etc., the action of the ions is fairly well estab- 
lished. Thus the effects of strong, hypertonic, weak or dilute, 
hypotonic, and normal, isotonic, salt solutions on blood-cells, on 
muscle-cells, and on nerve-cells are well known and readily explica- 
ble under the now known laws of ion dissociation. Space does 
not permit of a more extended discussion of this interesting phase 
of the subject. 

Physiological Action and Chemical Composition. — If the action of 
drugs is fundamentally a chemical one, then, on a priori grounds, 
it may be inferred that chemical compounds with similar dissociable 
ions will bring about similar physiological reactions. This general 
line of thought opens up a most fascinating field, which is daily 
offering more and more positive deductions, especially along the 
line of the newer synthetic preparations. 1 The newer work on ion 
dissociation alluded to in the previous paragraph is also to be con- 
sidered in this connection. 

Many years ago Blake suggested and worked out a complicated 
1 See Frankel, Arzneimittel Synthese, 1901. 



30 A TEXT-BOOK OF MA TERIA MEDICA. 

scheme of the toxicity of the metals, based on the periodic law of 
Mendeljeff, 1 but it would seem, for the present, that the time has 
not yet come when such relationships will prove of any practical 
interest. 

In the field of organic chemistry, however, the fundamental 
truths of the relationships of chemical structure and physiological 
action have given to pharmacotherapy some of its most highly 
prized drugs. The ingenuity of the pharmaceutical chemist is 
being taxed to the utmost in the search for new compounds. 

Along other lines equal diligence has been shown. Thus, a 
large number of the newer synthetic remedies have their draw- 
backs : their action is marred by certain unpleasant by-effects that 
have no relationship to the main action of the drug. Many are too 
readily soluble and exert a local action on the stomach, when it is 
desired that they reach the intestines ; others are insoluble and do 
not act where it is desirable to have them do so — as, for instance, 
many of the intestinal antiseptics and astringents. Many other 
illustrations might be instanced. 

One of the most fascinating problems connected with this sub- 
ject is that of the combination of the useful activities of different 
synthetics. Thus it is possible to combine a hypnotic acting radi- 
cle with an analgesic, and in one compound get a combination of 
the two. Other desirable combinations naturally occur. It is 
unfortunate that this problem has been often accomplished very 
satisfactorily from the chemical point of view, but when the physio- 
logical test has been applied, the compound has been worthless, 
both actions having been lost by some modification of one or the 
other main action. 

The possibilities of the problems are extensive, but the difficul- 
ties are many. One warning note should, however, be sounded. 
Notwithstanding the many excellent results that have been accom- 
plished by pharmaceutical chemists, there seems to be a tendency 
on the part of many to offer to the medical profession a vast number 
of so-called new synthetics. These are not at all new, but are 
well-known old compounds or very slight modifications of popular 
compounds that do not differ at all in their main actions. Such, 
by dint of extensive advertising and ingeniously devised " clinical 
reports," they force on the practitioner as very valuable new 
synthetics. . Reference is not here made to the imposition of the 

1 He showed that between certain limits there existed certain relations between the 
molecular weights, the spectrum analysis, and the physiological action of the metals. 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 31 

compounding of well-known remedies, such as acetanilid, etc., and 
the putting forth of the same under proprietary names as new syn- 
thetic compounds. Such are the sharks that prey upon the legiti- 
mate pharmaceutical chemist who is making honest efforts to give 
the profession much-desired remedies. They also prey on the 
community in that, under the guise of a secret name, they commit 
economic robbery, supplying at exorbitant rates what can be sup^ 
plied anywhere at rational prices. 

In connection with this subject it may be well to call the atten- 
tion of the student to the technical signification of the following 
terms : 

Pharmacopoeia {pharmakon, drug ; poiein, to make), a book com- 
piled by the government, or, as in the United States, a National 
Committee on Revision, and published by authority, establishing 
standards for the identification, purity, strength, and quality, and 
giving directions for the purification, valuation, preparation, com- 
pounding, and preservation of drugs, chemicals, and medicinal sub- 
stances. The United States Pharmacopoeia is revised decennially, 
the present (nth) edition having been adopted Jan. 1, 1894. 

Official — Officinal. — Unnecessary confusion prevails concerning 
the precise import of these terms. They are readily understood 
by reference to the Latin originals from which they are derived. 

Official drugs are those which bear the stamp of professional — 
i.e. official — sanction (Lat. officium, authority). They are prac- 
tically ordered by the Pharmacopoeia to be kept in all druggists' 
shops, the formulae being supplied by the work revised in decennial 
conventions. 

Officinal drugs are those prepared or kept by the druggist upon 
his own responsibility, bearing only the authority of the shop (Lat. 
officina, a shop). Such preparations are often included in works on 
Materia Medica, and, together with those emanating from other 
individual formulae, are marked " unofficial." 

The term " unonficinal," it will be seen, is a solecism ; and it fol- 
lows, moreover, that there are many preparations which are in 
pharmacy officinal, but not official, and that a pharmacopceial 
formula cannot possibly be officinal, although, speaking generally, 
all official drugs are officinal in that they are kept or prepared in 
the druggist's shop. 

Dispensatory. — This is a compilation of and commentary on 
one or more pharmacopoeias, enlarging the authoritative but re- 
stricted pharmacopceial formulae by including the medical and 



2)2 A TEXT-BOOK OF MA TERIA MEDICA. 

physical history of the various substances, with directions regard- 
ing dosage, together with observations on their physiological action 
and therapeutics. It also contains information concerning drugs 
not accepted by pharmacopceial authority, yet which are of occa- 
sional use or interest. The Dispensatory is in effect a private pub- 
lication and unofficial, in this respect differing essentially from 
a pharmacopoeia. There are in the United States various works 
of this character, the United States and National Dispensatories 
being commonly in use. 



CLASSIFICATION OF MEDICINES. 

The classification of drugs and remedial agents is a theme 
regarding which the many writers upon and teachers of medicine 
have shown a wider diversity of opinion, perhaps, than upon the 
physiological action and medical uses of individual remedies. The 
fact that therapeutics is far from being an exact science, and the 
rapid advance in our knowledge of normal physiological processes, 
of pathological conditions, and the systematic action of drugs, are 
sufficient explanation of the ever-changing judgments of our 
best observers concerning the action of certain medicinal agents 
under given conditions. 

It follows that from time to time, as appears in reviewing the 
literature of the subject, different writers, in their attempt to keep 
pace with the advancement of knowledge, have devised various 
systems of classification. 

In earlier days, when the therapeutist culled from the fields his 
simples for the cure of disease, there was naturally created a strong 
tendency toward a botanical classification. So far was the system 
pushed that in certain so-called schools of medicine the authority 
of Scripture was invoked, it being proclaimed as an axiom that 
" the leaves of the tree were for the healing of the nations " (Rev. 
xxii. 2). This eclecticism, strange as it may seem to-day, was the 
outgrowth of the Thompsonian or Botanical system of therapeutics. 
On the other hand, as an evolution of the old alchemic school, an 
attempt was made to found a classification by explaining the 
remedial action of all medicines upon a purely chemical basis. 

With the advent of more modern methods of study, applied to 
the physiological action of drugs upon the animal economy, came 
the physiological classification, in which the effects of remedial 
agents were explained upon rational grounds. 



CLASSIFICA TION OF MEDICINES. 33 

It is hardly necessary to state that coexistent with these various 
endeavors to attain a philosophical method of classification, com- 
plicating them and perplexing their votaries, the dominating prin- 
ciple of empiricism held universal sway, setting at defiance in many 
instances the cardinal maxims of rational therapeutics, the rational 
therapeutist even to-day welcoming as a last resort the cruder, 
though often efficient, empirical method. 

Some authors, perceiving the inutility of the older systems, 
have contented themselves with a mere alphabetical arrangement 
of medicinal agents, regardless of their origin, natural affinities, 
mode of preparation, and physiological action. 

With due respect for the many able and worthy efforts at 
classification recorded in the history of modern therapeutics, the 
author believes that the main object of classifying medicinal reme- 
dies — viz. to facilitate the retention of a vast number of valuable yet 
isolated facts — is best accomplished by grouping them along the 
lines of greatest practical utility. 

Remembering that the medical student of to-day is animated by 
an earnest effort to fit himself for the noblest sphere of usefulness 
— knowledge applied to the relief of human suffering — the author 
holds that the most philosophical, as well as practical, synthesis 
and comparison of remedial agents, based upon manifest physical 
and physiological relationships, will afford to the pupil the widest 
grasp, from a therapeutical standpoint. 

With the object of aiding the student, in accordance with this con- 
viction the author has endeavored in this work to give emphasis to 
a therapeutical classification, claiming for it no especial originality, 
but assured that the method he has selected is alike the most judi- 
cious and the one best calculated to respond to the demands of 
daily, practical utility. 

The thoughtful and logical student of medicine must realize that 
there are two great classes of remedial agents : 

I. Those used in cases which cannot be relieved by a single 
dose of any remedy, but require repeated and prolonged admin- 
istration. 2. Those employed in cases which are susceptible of 
immediate relief by the exhibition of a single dose. 

The remedies employed for the cure of the first class of cases 

have been appropriately styled Disease- or Organic- Medicines — an 

unscientific term, perhaps, yet useful to convey the intended idea, 

since they remove the cause of the departure from normal physio- 

3 



34 A TEXT-BOOK OF MA TERIA MEDICA. 

logical action in the living organism — i. e. perversion of functional 
integrity, or morbid conditions. 

Upon reflection it will be seen that remedial agents in the second 
class are, by the nature of the case, designed for the relief of some 
manifestation or change in the system or in its functions indicating 
the character, locality, severity, etc. of a morbid process — a symp- 
tom of disease. The remedies in this class, therefore, are termed 
Symptom- or Functional- Medicines, partly because of their specific 
virtue in relieving symptoms, partly from the fact that they produce 
certain manifestations characteristic of themselves. 

Disease -Medicines are usually administered for the relief or cure 
of chronic diseases. Symptom- Medicines are employed to relieve 
symptoms of, or prevent complications in, acute diseases — not for 
the cure of the disease itself. 

The classes named might be subdivided ad infinitum, yet it has 
seemed advisable to the author, for the sake of simplicity, to divide 
only the first class, Disease-Medicines, including the remedial agents 
employed therein, under three general heads, Restoratives, Altera- 
tives, and Aittiseplics. 

It is obvious to every reflecting physician that a class of reme- 
dies act as such by supplying some deficiency in the animal organ- 
ism, the agent in such cases being either itself the substance 
lacking, or its analogue, or by its presence restoring the deficient 
element or secretion. Iron or fats, for instance, act in certain forms 
of anemia in which these ingredients are wanting in the red blood- 
corpuscles ; phosphorus or the earthy salts behave similarly in 
conditions where the tissues are deficient in these necessary constit- 
uents; and bitters, though not natural ingredients of the system, 
act upon the gastro-intestinal mucous membrane, stimulating the 
glands to secrete a larger quantity of normal digestive fluid. 

In view of the physiological action of the remedies pertaining to 
this division, the term Restoratives so aptly expresses their general 
character that no apology is needed for its adoption. 

The second division, Alteratives, can be administered without 
injurious results only in diseased conditions, in which the particular 
remedy combats in a specific and occult manner the prime etiologi- 
cal factor of the pathological derangement. These medicines act 
properly only upon diseased organisms, their peculiar effect never 
being obtained by the exhibition of a single dose, but only after 
prolonged administration. They are unnatural to the system, and 
are more or less poisonous. Functional medicines are also un- 



CLASSIFICATION OF MEDICINES. 35 

natural to the system, but they are given only to relieve symptoms 
of disease, not for the disease itself; whereas Alteratives relieve the 
symptoms by removing the cause of the disease. The latter nor- 
mally produce no symptoms, the patient being unaware of their 
action save by a recognition of his gradually improved condition. 
Should, in fact, symptoms occur, they should serve as a warning 
that the remedy is not indicated or that the dose' is unsuitable. 

To elucidate this principle, the use of morphine to allay the pain 
of gout may be cited. A single dose is usually sufficient, yet it is 
not curative ; while colchicum acts as an alterative through its 
well-known specific and eliminative properties, and by continued 
treatment cures the disease. Again, caffeine may be employed to 
relieve anemic neuralgia, yet it may require hemic restoratives to 
alleviate the morbid condition producing the symptoms. 

A genuine alterative seems to have the property of antagonizing 
some disease. For instance, A and B are put under a prolonged 
course of mercury: A is salivated beyond recognition, while B's 
health improves — simply for the reason that B had syphilis, which 
A had not. At present the number of remedies which we are 
compelled to relegate to this class, Alteratives, for want of accu- 
rate knowledge regarding their modus operandi, is quite limited. 

The second great class of agents to which the name Symptom- 
Medicines is applied embraces all medicinal substances which, 
being introduced into the system, may produce by a single dose 
abrupt or serious disturbances of function. From the earliest his- 
tory of medicine they have offered a tempting field to the thera- 
peutist, because of the absolute certainty of their action in allaying 
symptoms or producing manifestations peculiar to themselves. It 
is perhaps superfluous to add that, owing to their extreme activity, 
the greater number of therapeutic errors may be ascribed to their 
use. 

To the young practitioner the charm of therapeutics lies in that 
class of agents which produce immediate and tangible results. 
These are obtained most readily by the remedies affording instant 
relief of prominent symptoms of disease, such as pain, pyrexia, 
insomnia, etc. Yet the author is here constrained to add a word 
of caution to the amateur therapeutist, reminding him that, in the 
maturer knowledge derived from subsequent experience, he will 
have less to regret should he confine his study and practice to 
physiological medication — that is, to the examination and adminis- 
tration of legitimate restoratives and alteratives — rather than yield 



36 A TEXT-BOOK OF MATERIA MEDICA. 

to the allurements presented by the energetic action of a large 
number of agents classed among Symptom-Medicines. 

The members of this class of remedies have been variously 
divided and subdivided by different writers on therapeutics. 

Antiseptics are classed among Disease-Medicines on account of 
their property of restoring to their normal condition the tissues, 
fluids, and secretions of the body by destroying the germs or 
micro-organisms which by their presence excite pathological 
processes. 

This great class, Antiseptics, embraces some of our most important 
neurotics. Most of them are antipyretic, and many of them possess 
analgesic and hypnotic properties. Instance, chloral, a powerful 
antiseptic, hypnotic, antipyretic, and circulatory depressant. Con- 
sidered only as an antiseptic, it would be classed as a Disease- 
Medicine ; clinically, however, it is used more as a hypnotic, and 
therefore in this work it is ranked as a Symptom-Medicine — a 
neurotic in the subdivision of Hypnotics. 

Drugs, in fact, exhibit so many different actions that an arbitrary 
line of demarcation between them is practically impossible, the 
author merely desiring to assign a given remedy to the class to 
which its chief therapeutic uses would naturally attribute it. 

The principal use of opium, as we know, is to relieve pain. It 
is the typical narcotic, yet it possesses astringent and hypnotic 
properties, and could therefore not inaptly be classed as an astrin- 
gent or hypnotic. 

It is already a question whether antipyrine should not be ranked 
in the division of Analgesics rather than Antipyretics, since, while 
formerly it was used almost exclusively for the reduction of tem- 
perature, we now know it to possess marked anodyne properties ; 
so that it is actually doubtful which is its more important use — to 
lower temperature or to relieve pain. 

These few illustrations serve to show how varied are the actions 
of drugs, and how their several divisions overlap one another. 
Thus, the last division of Disease-Medicines, Antiseptics, imme- 
diately precedes the first group of Symptom-Medicines, Antispas- 
modics, so closely are they allied, the last-named class possessing 
properties similar to those of that interesting division of Antisep- 
tics — the Aromatics. 

The next group, Antipyretics, is logically followed by Anes- 
thetics, and this in turn by Hypnotics, Narcotics, etc., each group 
being succeeded by the one most closely resembling it in physio- 



ADMINISTRATION OF REMEDIES. 37 

logical and therapeutic action. The last group comprises the 
Astringents, classed under Symptom-Medicines, these agents occu- 
pying the borderland between external and internal medicines. 

Caustics, the first group under topical remedies, naturally follow 
Astringents, since they differ from the latter drugs only in degree 
perhaps, as is well shown in sulphuric acid, which when diluted is 
an astringent, but undiluted an active caustic. 

A thoughtful study of drugs as classified in this work will, it is 
hoped, enable the student to become more familiar with the com- 
parative value of the various remedial agents than were possible 
had the author chosen an alphabetical arrangement, associating 
remedies having no possible relationship either in their actions or 
their medical uses. 



ADMINISTRATION OF REMEDIES. 

Remedies may be applied externally to the skin or internally to 
many mucous membranes, either as a local application or to bring 
about systemic action. 

Methods of Skin Medication. — The passage of drugs through 
the unbroken skin takes place in a small degree only. The follow- 
ing methods are applicable : Enepidermic method, consisting of the 
application of cataplasms, fomentations, washes, vapor-baths, etc. 
Epidermic methods, or the methods of inunction ; these are widely 
applicable. In such the drug is dissolved or suspended in some 
oily or fatty medium and made to penetrate the deeper layers of 
the skin by persistent and thorough rubbing. The thinner skinned 
portions of the body, such as the axillae, groins, beneath the knee, 
and inner elbow surfaces are those most frequently used. The 
method is valuable for general absorption, especially in the mer- 
curial administration for syphilis and in the use of methyl salicy- 
late (oil of wintergreen) in rheumatism, but it lacks precision in 
dosage. Endermic method, by which the skin is blistered and the 
drug is applied to the free corium ; it has many serious disadvan- 
tages. 

Hypodermic Method. — This consists in injecting the drug into 
the subcutaneous tissues by means of the hypodermic needle and 
syringe. Since absorption by the tissues takes place readily, it will 
be seen that this method of application is far more efficacious than 
those previously mentioned. Not all drugs, it is to be observed, 
are available for administration by the hypodermic process of 



38 A TEXT-BOOK OF MA TERIA MEDICA.\ 

injection. The eminent success attending the operation, however, 
renders it of signal value to the physician. 

This method was first used in a practical manner by Wood, of 
Edinburgh, in 1853. A syringe with glass rod and glass barrel 
accurately ground is the best now on the market. If carefully 
made, it will not leak and is never out of order. Those with metal 
barrels and leather washers dry out when not in constant use, 
and are never in condition when required. The all-glass syringe, 
moreover, can be sterilized at any time. This cannot be said of 
other varieties. A barrel holding about 30 minims is the usual 
size. After filling, all air should be excluded. The skin should 
be pinched up slightly, and the needle inserted rapidly and 
obliquely ; some prefer to insert the needle at right angles, but this 
is unnecessary, and if contaminated solutions should happen to be 
used, deep abscesses are produced. The insertion of the deltoid, 
outer aspect of the thighs, and deep muscles of the back are 
favorite sites. Solutions of drugs should not be used. It is pref- 
erable to use soluble hypodermic tablets ; these are best dissolved 
in a teaspoonful of water heated over a flame ; after cooling, the 
solution can be injected without causing pain. Prompt action 
follows this method, accurate dosage is assured, and disturbance 
of the gastric or intestinal mucosae is avoided. As a rule, the dose 
by this method is 25 per cent, less than when given by the mouth. 

Vaccination is a method of skin medication. In males it is best 
performed over the insertion of the deltoid, and in females there or 
at the upper outer portion of the leg. The thigh is troublesome 
to dress and necessitates greater exposure. For scarification the 
best instrument is a fine needle, which should be sterilized in a 
flame before using. The site selected should be cleansed thor- 
oughly with soap and water ; hard rubbing will aid in peeling 
away bacteria infected epidermis. Three or more scratches, \ of 
an inch apart and \ of an inch long, are then made, and the vaccine 
is rubbed in thoroughly either with a sterilized wooden toothpick 
or with the glass of a capillary tube. The capillary tube of 
glycerinated bovine lymph with a small balloon to expel the virus 
is the best form of virus now in use. With bovine virus the 
dangers from syphilis and tuberculosis are nil, and thorough 
cleansing of the arm avoids erysipelas or other septic infections. 

Hypodermoclysis is a method of applying remedial agents 
through the skin. As a rule, 0.6 per cent, normal salt solution is 
used — a dram of table salt to a pint of boiled and filtered water. 



ADMINISTRATION OF REMEDIES. 39 

The site preferred is the anterior wall of the abdomen or the ilio- 
lumbar region, above the ilium and below the ribs. Thorough 
asepsis is necessary in the technic. An ordinary fountain syringe 
with a moderate sized needle is all that is required. The solution 
is best used at a temperature of from 1 io° to 1 15 F., and from 4 
to 8 ounces are employed. The method is extremely useful in 
conditions of shock, hemorrhage, diarrhea, uremia, and in toxic 
states generally. 

Local Applications to Mucous Membranes. — The Eye. — Here 
lotions (collyria) of boric acid or hot water are applied. Oint- 
ments and caustics are. applied directly. Calomel may be dusted 
into the eye for sluggish chronic inflammatory conditions. 

The Ear. — This is reached by direct application, or by means 
of syringe. Alcoholic solutions of mild antiseptic drugs, such as 
boric acid, may be employed, the evaporation of the menstruum 
depositing the antiseptic in place. The ear is also reached by the 
Eustachian catheter from the inside. 

The Nose. — Direct application of caustics or astringents can be 
made to the nose. Sprays and insufflations of antiseptic solutions 
or powders are useful. For children one of the most efficient 
methods of cleansing the posterior pharyngeal vault, which often 
is necessary in scarlet fever, measles, influenza, etc., in order to 
avoid middle-ear infection, is to let the little patient lie on his back, 
and, by means of a tablespoon, the antiseptic solution can be 
placed directly in the nose. Children will permit, even enjoy, this, 
when no amount of coaxing will persuade them to submit to the 
use of a spray. Moreover, a spray rarely cleanses the entire nasal 
cavity. 

The Pharynx is reached best by direct application of absorbent 
cotton on an applicator. The applicator is made capable of being 
bent so as to reach the posterior pharynx. Solutions of cocaine, 
4 per cent., and freshly prepared solutions of suprarenal gland, 10 
to 50 per cent., are widely employed as local applications for anes- 
thetic and astringent purposes in these localities. Gargles are now 
largely superseded by direct applications, sprays, or by syrupy or 
mucilaginous solutions containing astringent drugs. 

Respiratory Tract. — As a means of producing anesthesia the 
respiratory tract has been utilized for some time. Opium is also 
taken in this manner by the opium-smoker. .The confirmed 
cigarette inhaler also utilizes the respiratory tract. In young 
children breathing of steam, medicated or not, is an efficient means 



4-0 A TEXT-BOOK OF MA TERIA MEDICA. 

for treating spasmodic laryngitis, bronchitis, and bronchopneu- 
monia. It is probable that the breathing of medicated vapors, as 
advocated by the disciples of the pneumatic cabinet, as a means of 
treating tuberculosis of the respiratory passages is largely illusory. 

Rectum. — Medication as well as feeding by means of the rectum 
is indicated in conditions of great irritability of the stomach or 
under special circumstances, such as stenosis of the esophagus, 
gastric cancer with stenosis of the cardiac entrance, hysterical dys- 
phagia, or in certain insane states, notably melancholia. Local 
disease may require local application of cautery, astringents, etc. 
By means of the proctoscope, enteroscope, or rectal specula, such 
topical applications may be made with ease and precision. Before 
making use of the rectal mucous membrane as a means for absorp- 
tion it should be cleaned thoroughly. The alkaline reaction of the 
mucus should be remembered in prescribing, else incompatibility 
may easily arise. Most drugs are absorbed much less rapidly 
through the rectal wall than through the stomach ; there are, how- 
ever, a few exceptions. These are notably strychnine, morphine, 
and iodine. Such is the teaching of many modern text-books. 
Personally, I have not been able to verify this. 

Enteroclysis, or intestinal hydrotherapy, as one author puts it, 
is a method of intestinal irrigation, including the use of enemata, 
used for the relief of a variety of conditions. It is a highly valu- 
able procedure. Any syringe will suffice, but for large quantities 
of water, the fountain or bag syringe is perhaps best adapted. 

Large quantities of fluid may be thrown into the bowel — as 
much as 9 pints may be used. If the temperature of the fluid is 
high, — ii5°-ii8°F., — there is less tendency to the development 
of intestinal cramps. When a large quantity of water is used to 
irrigate the bowel, its course may be followed by percussion, and 
its descent into the ascending colon noted. In this manner the 
cecum can be reached and thoroughly cleansed, a procedure of 
much value in the medical treatment of appendicular disorders. 
Normal salt solution may be used to subserve the same purposes 
as by hypodermoclysis. 

Suppositories afford a simple method of medication for local or 
for general purposes. 

Nutrient Enemata may be employed when, for any reason, the 
food cannot be made either to enter the stomach or to remain 
there. Small quantities — 3 or 4 ounces — are retained better than 
larger amounts. As the mucous membrane of the rectum does not 



ADMINISTRATION OF REMEDIES. 41 

have any digestive power, such enemata should be predigested, 
either by peptic or pancreatic ferments. Milk, oatmeal gruel, 
oysters, eggs and milk, peptonized, with mild alcoholic additions, 
as of sherry, make excellent nutrient enemata. 

Urethra. — Here direct application, irrigation, and suppositories 
afford the best means of medication. The cystoscope may be used 
here or for direct applications to the walls of the bladder. 

Stomach. — Medication by means of the stomach is the most 
convenient and practical method. The passage through the mouth 
and esophagus does not alter, to any great extent, the principles of 
drugs. Some drugs, such as strong acids, must be well diluted 
in order to protect the mucous membrane of the mouth and the 
enamel of the teeth. The administration of certain of the metals 
requires caution. Thus, some of the soluble iron preparations alter 
the color of the teeth somewhat ; lead acts injuriously if the teeth 
are carious ; and when mercury is being administered, the hygiene 
of the mouth must be carefully watched. In the stomach many 
drugs that are insoluble or slightly soluble in water are rendered 
more soluble by the weak acids ; many chemical reactions take 
place, which are further complicated as the drugs pass into the 
intestines and meet the alkaline fluids, the bile salts, and the prod- 
ucts of intestinal digestion. 

Intravenous Injection may be resorted to in desperate cases : its 
dangers are obvious, however, and, save for the purpose of trans- 
fusion after severe hemorrhage, it can seldom be attempted with 
impunity. 

Internal Administration. — The most obvious, and by far the 
most useful, method of internal administration is by the mouth ; 
yet care and discretion are to be used even in so ordinary a process, 
and the physician should consider thoughtfully the time, consequent 
effects, and chemical changes, that the drug may produce the most 
beneficial results. 

Inhalation is in many respects of the first importance as a 
method of internal administration. Its great facility in practice 
and its unquestionable efficiency — as in the case of anesthetics — 
render it readily available and highly beneficial, although the 
method has attained as yet only a limited use in therapeutics 
beyond a resort to it in pulmonary diseases. 

Enemata. — A different class of administrative operations consists 
in injections into the rectum, which injections may be purgative, 



42 A TEXT-BOOK OF MA TERIA MEDICA. 

anodyne, nutrient, emollient, astringent, anthelmintic, etc. For 
speedy and efficient cleansing of the large intestine the purgative 
enema is of incomparable value, care being taken that the quantity 
of the injection be sufficient, that it be passed up as far as possible, 
and that it remain as long as the patient is able to retain it. 

Absorbable enemata are usually small in quantity ; they have 
proved useful in certain cases of diarrhea and dysentery, and are 
serviceable when the act of swallowing is precluded by affections 
of the esophagus or in cases where the stomach requires complete 
rest. The rectum, however, possessing no digestive capacity, the 
injection should consist of the simplest materials and contain pepsin 
and acid or pancreatic fluid. 

Another mode of securing beneficial results from internal admin- 
istration through the absorptive properties of the intestine is by 
means of suppositories, readily introduced within the sphincter ani 
and dissolving at the temperature of the body. 

To take the place of intravenous injection, normal solution, 0.6 
of I per cent, is used as an enema in all conditions where the 
former is indicated, especially after major operations. From 7 to 
17 fluidounces (207-503 Cc.) are injected, according to the indi- 
vidual tolerance of the patient. These injections are to be repeated, 
in the endeavor to secure the absorption of from 2 to 6 quarts 
(liters) of the solution in the course of twenty-four hours. 

Dosage. — The term dose implies the quantity of a medicinal 
agent which under certain conditions it is advisable to administer, 
many considerations entering into the question, to be weighed by 
the features of the individual case. Dosage may be regarded as 
perhaps the most vulnerable point in therapeutic science, yet one 
upon which the art of healing almost wholly depends. 

Since Heller in 1755 enunciated his philosophical maxims 
touching the rational method of testing the therapeutic effects of 
drugs, eminent clinicians have sought to solve the mysteries attend- 
ing the action of various remedies whose modus operandi remains 
to this day obscure. Indeed, so great is the diversity of operation 
pertaining to the commonest remedies, conditioned by the character 
and circumstances of the case, as well as the amount and quality 
of the drug, that it is next to impossible to predicate the precise 
effects of agents whose physiological properties are theoretically 
and even practically established. The ordinary adult dose of 
opium, for instance, is 1 gr. (0.06 Gm.) ; yet in certain diseases, 



ADMINISTRATION OF REMEDIES. 43 

such as peritonitis, ten times that amount may be required to 
relieve the pain. The doses given in many text-books differ 
materially from those prescribed in actual practice, being- in- 
tended to express only the average quantities to be admin- 
istered, the exact amounts varying with the conditions of the 
particular case. These conditions may be classed under the 
heads of age, sex, temperament, idiosyncrasy, habit, state of the 
system, temperature of the body, time of administration, intervals 
between doses, cumulative action of the drug, and the contingent 
considerations of diet, climate, race, etc. — oftentimes a complicated 
problem even to the most skilful therapeutist. A few suggestions 
regarding the leading characteristics of dosage, as limited by these 
various circumstances, may be of value to the student. 

The influence exercised by Age is indubitable, as a rule the 
young requiring smaller doses than adults, the aged being least 
susceptible to therapeutic impressions. With regard to children 
several mathematical formulae have been devised, none of which, 
however, has proved infallible — least of all those based upon 
adult dosage, itself subject to no little uncertainty. Nor can 
deductions as to the efficacy of a given dose be drawn from 
che action of drugs with which the agent is naturally asso- 
ciated. A single drop of laudanum has been known to pro- 
duce the death of an infant, whereas large doses of belladonna, 
conium, arsenic, and mercury have been taken with comparative 
impunity. 

The most convenient rule (Young's) adds 12 to the child's 
age and divides by the age to get a denominator of a fraction 
whose numerator is 1, this fraction representing the proportion 
between adult and infant doses. Thus, for a child three years old 

3+12 

— - — = 5, or \, the dose being one-fifth of that given to an adult. 

Temperament acts as an important agent in modifying the effect 
of medicinal remedies, phlegmatic subjects readily tolerating cer- 
tain medicines, such as opium, which those of nervous temperament 
are unable to bear. Stimuli act upon sanguineous patients forcibly, 
yet upon others their influence may be either tardy or ineffectual. 
The condition is one which discloses a wide field of inquiry, the 
mental, moral, and physical tendencies of the individual being 
involved in the practical administration of medicines. 

Closely allied to the foregoing is the question of Idiosyncrasy, the 



44- A TEXT-BOOK OF MA TERIA MEDICA. 

constitutional peculiarity which exerts a subtle influence, scarcely 
understood, as potent as it is obscure. Its characteristics cannot 
be formulated, but must be studied with the aid of experience — an 
odor, a taste, a casual or fixed impression, or hereditary instinct 
often determining their existence and manifestation. In tempera- 
ment and idiosyncrasy, indeed, the psychological rather than the 
physiological side of therapeutics is developed, requiring for its 
treatment a professional acumen not always at command. 

The influence of Habit is to diminish the susceptibility of the 
organism to impressions which under normal conditions would be 
speedy and effectual. Only by gradually increasing the quantity 
of the dose can results be obtained which in ordinary circumstances 
require few exhibitions. Thus, patients accustomed to the use of 
alcoholic stimulants accept heroic doses of alcohol with little or no 
indication of the effects quickly perceptible in temperate subjects. 

Bodily condition obviously affects the action of remedial agents. 
It is well established that in severe pain opium may be adminis- 
tered in quantities which in a healthy organism would produce 
untoward, perhaps fatal, results. The salivation occasionally caused 
by mercury is seldom apparent in febrile conditions. Yet in cases 
where sensibility is diminished great care is necessary to avoid the 
deleterious effects of over-stimulation or excessive dosage. 

Respecting Sex, although it is generally admitted that females 
require smaller doses than males, the exceptions to the rule are so 
numerous as almost to vitiate the accepted theory. 

The Time of Administration is closely connected with the Form 
of the Remedy given, as a rule remedies being withheld immedi- 
ately before and after meals. The practice, however, is subject 
to modifications, certain drugs acting best on an empty stomach, 
and others, such as local irritants, being more safely diffused when 
the stomach is full, in which case by mingling with the food they 
are not brought into irritating contact with the intestinal mucous 
membranes. 

With regard to Intervals between Doses it may be said, in brief, 
that they are to be determined by the special features of the case, 
the character and potency of the drug, and the degree of tolerance 
and assimilation evidenced by the patient. Every remedial agent, 
under normal conditions, produces a specific and definite action, 
the system by absorption and elimination limiting the period of its 
efficacy in cases of prolonged treatment, so that the drug is evi- 



ADMINISTRA TTON OF REMEDIES. 45 

dently to be renewed in order to secure perfect results. Failure to 
continue treatment has frequently proved disastrous, even fatal, to 
the patient, and it should be borne in mind that, in the absence of 
contraindications or untoward effects, a primary object of dosage is 
to create and maintain an impression upon the morbid system. 
Knowledge of therapeutic action and a thorough understanding of 
pathological conditions can best determine the interval requisite to 
attain the most beneficial effect of successive dosage. 

Other considerations — by some therapeutists held to be of mi- 
nor, by others of paramount, importance — affect the vital question 
of dosage. The emotions, for example, play an interesting part in 
the toleration or rejection of remedial agents. Strangely enough, 
too, the imaginative faculty is often a cause of idiosyncrasy, numer- 
ous instances being adduced by reputable authorities wherein 
either positive or fancied ills were affected through the agency of 
spurious remedies — bread-pills, deceptive concoctions, and the like 
— the ethical aspect of therapeutics being here left to the conscience 
of the physician. 



UNTOWARD EFFECTS OF DRUGS. 

Drugs given a specified patient, a victim of acquired or in- 
herited defect, will produce in that patient unexpected results dif- 
fering from their usual action. These results, which should not be 
classified with typically poisonous effects or with those of pro- 
longed use, may not appear in many cases, and do not correspond, 
as a rule, with the admittedly poisonous symptoms. They have 
been termed in Germany " nebenwirkungen," in France " incon- 
venients therapeutiques," and among the English-speaking nations 
"untoward effects" and "bye-effects." The following summary 
has been made of these from those tabulated by Drs. W. L. Baum, 
and J. G. Kiernan of Chicago, Lewin of Berlin, Germany, and Mul- 
heron of Detroit, Mich. 

Untoward effects are of great interest from a medico-legal 
standpoint. Even physicians are but too apt to refer them to 
defects or impurities in the drug dispensed. They are seemingly 
multiform in character, and yet they can readily be ranged under a 
few general laws. The primary and secondary effects, which are 
often opposite in nature, the organs chiefly affected by the ordinary 
action of the drug, the method of drug-excretion, all play a part in 
what may be called general constitutional untoward effects, as con- 



46 A TEXT-BOOK OF MATERIA MEDIC A. 

trasted with the untoward manifestations due to temporary and 
evanescent conditions, which last, however, also range themselves 
in a regulated fashion. 

Prediction may be made with considerable accuracy as to the 
untoward effects of any drug on learning its action and all the 
factors cited. An antipyretic will have as untoward effects, skin- 
eruption because it is excreted through 'the skin, because the skin 
through its pores regulates temperature, and hence is under control 
of the central nervous system regulating temperature, and, finally, 
because the skin is in close connection from an early period with 
the nervous system. For the same reason profuse, debilitating 
perspiration often results. Since control of the temperature cannot 
be effected without control of the vasomotor system regulating the 
blood-supply, heart-failure, collapse, and palpitation may result, 
together with certain eye- and ear-symptoms. 

If the drug be one which tends to cause slight brain vasomotor 
disturbance, such as results from what is known as a tonic action, 
then delirium, blindness, and deafness of a temporary character are 
produced. Temperature in the human subject is regulated by the 
three systems of nerves : thermotaxic or heat-regulating, thermo- 
excitory or heat-increasing, and thermo-inhibitory or heat-decreas- 
ing. As a more or less exact balance is kept by these centers, undue 
action of any of them constitutes a morbid state. If the thermo-in- 
hibitory centers be too much stimulated, they may lose their control : 
hence in certain individuals temperature rises after an antipyretic. 

Hahnemann, an individual with a neurotic constitution, had an 
easily upset temperature-regulator, whence his experiments on him- 
self with cinchona resulted in this phenomenon, which has since 
been observed by Denk and others from quinine and cinchona 
preparations. The action on the heart may, by its influence on the 
kidney-circulation, cause kidney- and bladder-symptoms even to 
the extent of albumin in the urine. If the antipyretic be excreted 
through the kidneys, albuminuria is especially likely to present 
itself as an untoward result. Alteratives and purgatives produce 
hemorrhages from the mucous membranes and swelling of those 
of the organs of special sense, beside skin-eruptions. Hypnotics 
through their action on the central nervous system produce exces- 
sive perspiration, skin-eruptions, vertigo, and heart-collapse. Astrin- 
gents cause diarrhea and bloody intestinal discharges. Diaphoretics 
cause pains at certain points from over-stimulation. Pilocarpine 
causes at times pain in the penis ; as there often occur in certain 



UNTOWARD EFFECTS OF DRUGS. 47 

persons excessive secretion and plugged sebaceous glands around 
its head, the pain and other resultant symptoms simulate chancre. 

In classifying tonics and alteratives together in the first table the 
influences of the trophic nervous system, evident in the constitu- 
tional changes produced by diseases like typhoid fever, must be 
taken into account. Alterative drugs have much the same con- 
stitutional effects, according to the theory of their action now. 
coming into general acceptance. 

It will be observed from the annexed tables (see pages 48-53) 
that the most potent tonics and alteratives are most fertile in 
untoward effects. This is naturally to be expected. A drug of 
potent physiological action must of necessity try more severely 
inherited and acquired deficiencies of constitution than an inert 
drug. Too excessive strain on inhibitions weakened by acquired 
or inherited taint gives an undue sway to inhibited centers. Un- 
toward effects of drugs may hence be conditioned on pre-existing 
affections of the inhibitory apparatus of the system. 

One influence which, together with hereditary or acquired 
defect, plays a part in determining untoward results is what 
the Germans call the " etiologic moment." This is excellently 
illustrated in the neurotics, which display such decidedly variable 
untoward effects. In many neuroses nerve-strain of the elimi- 
native and assimilative organs has produced toxins and other 
products ; some of these naturally add to the effects of a given 
neurotic drug, or direct these in some special channel or inhibit 
certain effects, thereby giving others undue play. This may con- 
stitute, as Lewin has shown, a disposition that is but temporary, 
which disposition may have its foundation either in a greater 
abundance in the system of bio-chemical substances, which cause 
an unusually prompt solution or action of the medicines intro- 
duced, or which may unite with them to form injurious com- 
pounds ; or it may be conditional on pre-existing pathologic 
changes in the inhibitory apparatus of the system. 

The tables given on pages 48-53, covering all the departments 
of the materia medica, will give a better idea of these untoward 
effects than any detailed description. 



4 8 



A TEXT-BOOK OF MA TERIA MEDICA. 



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A TEXT-BOOK OF MA TERIA MEDICA. 



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54 A TEXTBOOK OF MATERIA MEDICA. 



WEIGHTS AND MEASURES. 

The history of Weights and Measures affords a striking example 
of the incongruity resulting from the absence of a uniform standard 
of stable value to science, and must be regarded as the strongest 
argument in favor of the Metric, or Decimal, System. 

An idea of the confusion prevailing under the old methods may 
be gained from an examination of their comparative units, by which 
we find that a pint is not a pound, an ounce not equal to a fluid- 
ounce, a drachm not equivalent to a fluidrachm, and a minim not 
commensurate with a grain. It was not until 1836 that the Secre- 
tary of the U. S. Treasury was directed by Congress to furnish each 
State in the Union with a complete set of revised standards, includ- 
ing the troy pound of 5760 grains, from which the Apothecaries', 
or Troy, weight is derived, the latter term at present being applied 
only to the system used in weighing precious metals. 

For commercial purposes the following Weights and Measures 
are employed : 

Avoirdupois Weights : the Pound divided into 16 Ounces. 

Liquid Measures : the "Wine Measure," of which the U. S. 
Gallon represents a volume of 231 cubic inches; each cubic inch 
of water at the maximum density (4 C.) being equivalent to 
252.892 grains, the weight of a Gallon being therefore 58,418 
grains. The Gallon is divided into 8 Pints (octarius), and the Pint 
is divided into 16 Fluidounces, each containing 8 Fluidrachms, 
or 480 Minims, the Fluidrachm containing 60 Minims. The signs 
used to designate these units are — TT[, denoting minim or minims ; 
iZy fluidrachm or fluidrachms ; and f %, fluidounce or fluidounces. 

Apothecaries' (Troy) Weight. 

20 grains (gr. granwn) = 1 scruple d {scrupidum). 
60 grains, or 3 scruples = 1 drachm 3 {drachma). 
480 grains, or 8 drachms = 1 ounce 3 (uncid). 
5,760 grains, or 12 ounces = 1 pound ft) {libra). 

Apothecaries' (Wine) Measure. 

60 minims (ttl) = 1 fluidrachm f 3. 

480 minims, or 8 fluidrachms = 1 fluidounce f^. 
7,680 minims, or 1.6 fluidounces = I pint O {octarius). 
61,440 minims, or 8 pints = 1 gallon C {congius). 



WEIGHTS AND MEASURES. 



55 



This lack of uniformity in the units and the denominations of 
the three systems of weights and measures is exemplified in the 
subjoined table. While the two weight systems have a unit in 
common, the grain, there is no correlation in the higher denomina- 
tions, ounces and pounds. The desirability of adopting a fixed 
standard, applicable in aW cases where great accuracy in weights 
and measures is requisite, has been frequently emphasized by 
writers on therapeutics. As we have premised, the present diffi- 
culty forms a cogent argument in favor of the metric system, as 
wisely adopted in the U. S. Pharmacopoeia. A remarkable dis- 
parity is shown in the liquid measures, in which there is no unit 
in common : a minim is not a grain, nor " a pint a pound the world 
around." 

Table of Apothecaries' Weight and U. S. Liquid Measure, showing the 
equivalents of the various denominations (by reading from the left-hand column 
and referring to headings), the weight equivalent of liquid measures being for water 
at 15 C: 



Symbol. 


Minim. 


_ Scru- 
Granum.| pu i us _ 


Drach- 
ma. 


Fluid- 
drachma. 


Av. 
ounce. 


Fluid- 
uncia. 


Uncia. 


Libra. 


Av. 
pound. 


Octa- 
rius. 


Con- 
gfius. 


m. 

gr- 

5 
f5 

av. oz. 
fl. 3 

B 

lb. 

lb. av. 

0. 
Cong. 


i 
0-95 

63 

60 

480 

7,680 
61,440 


o.95 
1 

20 

60 

57 
437-5 

456 

480 
5,760 
7,000 
7,292 


20 

1 
3 

24 
288 
35o 


57 
60 
3 

1 

Y 

96 

n6§ 


60 
57 

1 

7§ 

8 

128 
1,024 


437-5 

7B5 

7l 
if 

16 


480 
456 

Y 

I 

l6 

128 


480 
24 
8 

8* 
0.9115 

1 

14.58 


5,76o 
288 
96 
100 
13* 

12 

1 
0.823 


7,000 
350 

110J 
16 

14.58 
1. 215 

1 


7,680 
7,300 

128 

It 

1 
8 


61,440 
58,400 

1024 
128 

Y 

1 




Minim. 


Grain. 


Scru- 
ple. 


Drachm. 


Fluid- 
drachm. 


Av. 
oz. 


Fluid- 
ounce. 


Apoth. 
orTr. 


Apoth. 
or Tr. 
pound. 


Av. 
pound. 


Pint. 


Gal- 
lon. 



THE METRIC SYSTEM. 

The Metric System of Weights and Measures, destined to sup- 
plant all others, originated with Prince de Talleyrand, bishop of 
Autun, in 1790. Its almost universal adoption by civilized nations, 
its legality, though not compulsion, in England and the United 
States, and its adoption by the U. S. Pharmacopoeia of 1890, 
require that it should be understood alike by the physician and 
the druggist. Save in the English-speaking world it is the only 
system used for governmental, statistical, and scientific purposes, 
and in the arts and manufactures its value has long since been 
recognized. Its extreme simplicity, its uniformity, and its facility of 
computation render it far superior to any other system of Weights 
and Measures, and it is highly pvobable that in tne near future it 



56 A TEXT-BOOK OF MATERIA MEDICA. 

will prevail in the transactions of every-day life, as it has already 
acquired international importance, and is in fact referred to as the 
International System. 

The starting-point is the unit of length, the meter {metre), which 
is the 4o-owoo"o P art °f tne earth's circumference around the poles. 1 
From this apparently irrelevant measure of length the unit of 
capacity, or volume, the liter, was established, it being the cube of 
-^ of a meter. With equal simplicity and clearness, from the meter 
was derived the unit of weight, the gramme, which is the weight 
of that quantity of pure water at the maximum density, 4 C. 
(39.2 F.), which will fill the cube of y^ part of a meter 2 (cubic 
centimeter). 

The Metric is also known as the Decimal System, because its 
multiples and subdivisions are obtained by ten (Lat. decern). The 
prefixes denoting multiplication are of Greek derivation, and are 
usually spelled with a capital letter: Deka 10, Hecto 100, Kilo 
1000, Myria 10,000. Division of the units is indicated by Latin pre- 
fixes, not capitalized : deci -^, centi y^-, milli y^Vxr- To distinguish 
readily one process from the other the word GILD has been aptly 
suggested as a mnemonic : 

GILD. 

Greek increases, Latin decreases. 

Contrary to a prevalent opinion, the Metric System is easily 
mastered. A perfect acquaintance with the metric tables is, nat- 
urally, indispensable, and the abbreviations for the different weights 
and measures should be thoroughly at command. For the rest, 
the system is simply that of arithmetical decimals, requiring chiefly 
a correct use of the decimal point. Only a tyro would read .065 
six and five-tenths hundredths instead of sixty-five thousandths ; so 
Gm. .065 would never be read by one acquainted with decimals 

1 In 1806, Francois Arago and Biot were commissioned by the French government 
to complete the meridional measurements interrupted in 1804. The object of their 
survey was to determine, with as great nicety as possible, the ten-millionth part of a 
quadrant of the meridian passing through Paris, which had been chosen by the National 
Convention as the standard unit of length, and named the mitre. It being impossible to 
measure from the poles, an arc of the meridian, equalling a quadrant, from Dunkirk to 
Barcelona was selected, and from their known difference of latitude the entire length of 
the arc was deducted. 

2 The unit of surface measure, the are, the square often meters, and the unit of the 
solid measure, the stere, having the capacity of a cubic meter, need not claim the atten- 
tion of the physician or the practical pharmacist. 



WEIGHTS AND MEASURES. 



57 



six centigrammes and five milligrammes, but sixty-five milli- 
grammes. 

Metric Table of Lengths. 

io millimeters make I centimeter. 

I decimeter. 



io centimeters 
io decimeters 
io Meters 
io Dekameters 
io Hectometers 
io Kilometers 



i Meter, 
i Dekameter. 
I Hectometer. 
i Kilometer. 
I Myriameter. 



Abbreviations for the different divisions and multiples of the 
Meter are herewith given, together with their equivalents in inches, 
showing that the written system depends wholly upon the place 
of the decimal point, the figures remaining unchanged. It may be 
noted that the first abbreviations cited are those commonly in use, 
although in certain cases the second are preferable : 

Metric Table of Linear Measure. 

I millimeter is written I mm., or M .ooi, equal in inches to 

I centimeter " 

I decimeter " 

I Meter " 

I Dekameter " 

I Hectometer " 

I Kilometer " 

I Myriameter " 

The term micromillimeter ; one-thousandth of a millimeter 
(o.oooooi), is used, especially in microscopy, the abbreviations 
being mmm., mic, mkm., or the Greek letter //. 

Metric Table of Capacities, 
io milliliters make I centiliter. 



cm., 


" M .01, " 


dm., 


" M.i, 


M., 


" M i., 


Dm., 


" M io., « 


Hm. 


" M i oo., « 


Km., 


" M iooo., ' 


Mm. 


" M ioooo., ' 



to .039370432, 


approx. ^. 


.39370432, 


0.4 


3-9370432, 


4- 


39.370432, 


» 40. 


393.70432 




3937.0432 




39370.432 




593704.32 





10 centiliters 
10 deciliters 
10 Liters 
10 Dekaliters 
10 Hectoliters 
10 Kiloliters 



I deciliter. 

1 Liter. 

1 Dekaliter. 

1 Hectoliter. 

1 Kiloliter. 

I Myrialiter. 



Abbreviations for the different divisions and multiples of the 
Liter, with their corresponding equivalents in minims or ounces, 
are as follows : 



58 



A TEXT-BOOK OF MATERIA MEDIC A, 



I milliliter is written I Cc. x or L .001, equal in minims to 16.23 

162.3 
" 1623. 

fl. ounces 33814 

338.14 
3381.4 
33814. 
338140. 

Metric Table of Weights. 
10 milligrammes make 1 centigramme. 



1 centiliter 


" 


1 cl. 


" L .01, 


I deciliter 


" 


1 dl. 


« L .1, 


1 Liter 


a 


1 L. 


« L 1., 


1 Decaliter 


« 


1 Dl. 


" L 10., 


1 Hectoliter 


« 


1 HI. 


" L 100., 


1 Kiloliter 


« 


1 Kl. 


" L 1000., 


1 Myrialiter 


n 


1 Ml. 


" L 10000. 



10 centigrammes 
10 decigrammes 
10 Grammes 
20 Dekagrammes 
10 Hectogrammes 
10 Kilogrammes 



L decigramme. 
1 Gramme. 
1 Dekagramme. 
1 Hectogramme. 
1 Kilogramme. 
1 Myriagramme. 



Abbreviations for the different divisions and multiples of the 
Gramme, with their corresponding equivalents in grains, are as 
follows : 



1 milligramme is written 


1 mg., 


or Gm. .001, 


equal in grains 


to (^ 


) .OI5432 


I centigramme " 


1 eg., 


" Gm. .01, 


" " 


(*) 


.15432 


1 decigramme " 


idg., 


" Gm. .1, 


" 




1.5432 


1 Gramme " 


1 Gm., 


" Gm. 1., 


" " 




15-432 


1 Dekagramme " 


1 Dg., 


" Gm. 10., 


« << 




154.32 


1 Hectogramme " 


iHg., 


" Gm. 100., 


<« « 




1543-2 


1 Kilogramme " 


1 Kg., 


" Gm. 1000. 






15432.3 


1 Myriagramme " 


iMg., 


" Gm. 10000 


., " " 




1543234 



METHOD OF CONVERTING METRIC WEIGHTS, MEASURES, AND 
LENGTHS INTO THOSE IN COMMON USE, AND VICE VERSA. 



I gram 



Approximate Table of Weights. 

= 0.65 Gm. (65 milligrammes). 



151 grains 


= 


1. Gm 


1 drachm 


= 


3.9 Gm 


1 troy ounce 


= 


31. 1 Gm 



Approximate Table of Capacities. 

I minim = .06 Cc. 

16 minims = 1. Cc. 

1 fluidrachm = 3.75 Cc. 

1 fluidounce = 30. Cc. 

1 This is designated by Cc. instead of Ml, and in practice only cubic centimeters and 
Liters are employed. 



WEIGHTS AND MEASURES. 59 

Approximate Table of Lengths. 

I inch = .025 M. (25 millimeters). 
40 inches = 1. M. 

Weights. 

To Convert Grains into the Corresponding Metric Equivalents. — 
It has been seen that 1 grain is equal to Gm. .065. In order, then, 
to convert grains or fractions of a grain into the corresponding- 
metric quantity, we have simply to multiply the number of grains 
by .065. 



2 grains = 


2 X 


.065, 


or .130 Gm. 


60 grains = 


60 x 


.065, 


" 3.9 Gm. 


\ grain = 


\ of 


.065, 


" .0325, Gm. 


TW g rain = 


tU of 


.065, 


" .00065 Gm. 



065, 


or 2 


grains 


065, 


" 60 


grains 


.065, 


" -5 


grain. 


.065, 


" .01 


grain. 



etc. 

To Convert Metric Quantities into their Equivalent in Grains. — 
Instead of multiplying as above, divide, using the same number, 
.065, as a divisor. 

Gm. .130 = .130 
Gm. 3.9 = 3.9 

Gm. .0325 = .0325 -*- 
Gm. .00065 = .00065 -fr- 
it follows that to convert Apothecaries' drachms into Grammes 
we multiply the number of drachms by 3.9, the number of Grammes 
in 1 drachm ; and to convert Grammes into Apothecaries' drachms 
we divide the number of Grammes by 3.9. 

The same rule applies to the conversion of Apothecaries' ounces 
into Grammes and Grammes into ounces, the multiplier and divisor 
being 31.1, the number of Grammes in 1 ounce. 

Volumes. 

To convert minims into the corresponding metric equivalents, 
multiply the number or fractions of minims by .06, this being the 
equivalent in Cc. of 1 minim ; and to convert the metric quantities 
into the corresponding equivalents in minims, divide the metric 
quantity by .06. To convert fluidrachms into Cc, multiply the 
number of drachms by 3.75, the number of Cc. in I fluidrachm ; 
and to convert Cc. into fluidrachms, divide the number of Cc. by 
3.75. To convert fluidounces into Cc, multiply the number of 
ounces by 30. Cc, the equivalent of 1 fluidounce ; and to convert 
Cc into fluidounces, divide the number of Cc by 30. 



6o 



A TEXT-BOOK OF MATERIA MEDICA. 



For convenience of ready reference and to facilitate computa- 
tion the following tables are subjoined : 



Table of Metric Equivalents 

of Grains, Drachms, Minims, and Fluidrachms. 



X 


Grains. 


Milligrams, 
mg. 


Centigrams, 
eg. 


Decigrams, 
dcg. 


Grammes, 
Gm. 


Minims. 


Cubic centi- 
meters, Cc . 


1 




TTfa 


O.65 


O.065 


O.0065 


O.OO065 










A 


O.85 


O.085 


O.O085 


O.OO085 










A 


I. 


O.I 


O.OI 


O.OOI 










i 

5(5" 


1-3 


O.I3 


O.OI3 


O.OOI3 










A 


2-5 


O.25 


0.025 


O.OO25 










A 


6.5 


O.65 


O.065 


O.O065 










i 

"5" 


13. 


1.3 


O.I3 


O.OI3 










f 


1 6. 


1.6 


O.I6 


O.OI6 










32. 


3-2 


O.32 


O.O32 












65. 


6.5 


O.65 


O.065 


I 


O.06 






2 




13- 


i-3 


O.I3 


2 


O.I2 






3 




20. 


2. 


0.2 


3 


O.I8 






4 




25- 


2.5 


O.25 


4 


O.24 






5 




3<>- 


3- 


0.3 


5 


0.3 






7* 




5o. 


5- 


0.5 


8 


0.5 






IO 




65. 


6-5 


O.65 


10 


O.6 






15 




IOO. 


10. 


I. 


16 


I. 






20 






13. 


13 


20 


1.25 






30 






20. 


2. 


32 


2. 




3J 


60 






40. 


4. 


60 


3-75 


m 




IOO 






65. 


6.5 


IOO 


6. 




3*J 


I20 






80. 


8. 


120 


7-5 


f^j 




I50 






IOO. 


10. 


150 


9- 




3»J 


ISO 
200 








12. 

13- 


180 
200 


11.25 
12. 


f3«j 


3 iv 


240 








16. 


240 


15. 


fsjiv 


3 V 


300 








20. 


300 


18. 


f^v 


3 V J 


360 
4OO 








24. 
26. 


360 
400 


22.5 
24. 


W 


3 vi J 


420 
450 








28. 
30. 


420 
45o 


26.25 
27. 


f£vij 


a 


480 








32. 


480 


30. 


Si 



Equivalents. 
Various methods have been proposed for adapting the metric 
weights to our apothecaries' weights used in prescription writing 
without entailing calculations in fractions. The method of taking 
32 Grammes as equivalent to one troy ounce, and 30 Cc, or fluid 
Grammes, as equal to one fluidounce, seems to be the least objec- 
tionable. These equivalents are shown in the following : 

32 Gm. = 1 ounce ; 32 -=- 8 = 4. Gm. = 1 drachm. 

30 Cc. = 1 fluidounce ; 30 -s- 8 = 3.75 Cc. = 1 fluidrachm. 

The exact metric equivalent of I grain is obtained by dividing 
the unit by the Gramme equivalent in grains; thus, 1. -*- 15.432 = 
0.0648 Gramme (or 6J- centigrammes). 



WEIGHTS AND MEASURES. 



61 



The metric equivalents of all the other denominations may be 
obtained by multiplying the grain equivalent by the number of 
grains in one drachm ; the number of drachms in a troy ounce, etc. 
The following exact Gramme equivalents are thus obtained : 

I grain. I drachm. I ounce av. I ounce troy. I lb troy. ■ I lb av. 
0.0648 3.888 28.349 31.103 373- 2 5 453-592 

To convert avoirdupois or troy into metric weights, the equiva- 
lent of the Gramme in grains — 1 5.432 — should be remembered, as it 
serves the purpose of a basis for obtaining the equivalent of all the 
higher denominations. 

Table of Metric Equivalents 

of Ounces (Apoth., Av., and Fluid) in Grammes and Cubic Centimeters. 



Ounces, 


I 


Grs. 


Grammes, 


Fluidounces, 


Cubic centimeters, 


Exact 


Apoth., 


Gm. or G. 


fj 


Cm. or Cc. 


equivalents. 




1 




31 


I 


30 


29-57 




2 




62 


2 


60 


59-15 




3 




93 


3 


90 


88.72 




3 


103 


100 


3.38 


IOO 






4 




124 


4 


I20 


118.3 




5 




155 


5 


I50 


147-87 




6 




186 


6 


180 


177-44 




7 




217 


7 


2IO 


207.01 




8 




248 


8 


240 


236.59 




8 


18 


250 


8.45 


250 






9 




280 


9 


270 


266.16 




10 




3ii 


10 


300 


295-73 




11 




342 


11 


330 


325-3I 


I ft) 


12 




373 


12 

1 pt. 16 

■7 A 


360 
480 

500 


354-88 
473-18 


Av. 


Ounces. 


Grs. 


453-6 


Ift) 


16 








17 


278 


500. 


20 


60O 


591-47 




20 




566.8 


24 


720 


709.77 




24 




680. 


2 pt. 32 


960 


946.35 




28 




793-2 


34 -h 


IOOO 




2 ft) 


32 




907.25 


3 P t. 48 


I440 


1419. 




35 


I20 


1000. 


4 pt. 64 


I920 


1892.71 


3 tt> 


48 




1360. 


68 -h 


2000 




4 ft) 


64 




1814-5 


5 pt- 80 


2400 


2365-9 




70 


240 


2000. 


100 


30OO 


2957-37 


5 ft) 


80 
100 




2268 
2835 


1 gal. 128 


3840 


378543 


10 ft) 


160 




4536 









It will be noted that in the Pharmacopoeia of 1890 the Gramme 
(Gm.) and the Cubic Centimeter (Cc.) are the only metrical terms 
used. The reason of this is simply that these two terms express 
sufficiently the quantities ordinarily handled, the remaining ones 
being excluded to avoid confusion, Grammes and Cubic Centi- 
meters standing as perfect equivalents of ordinary weights and 
measures, as the foregoing tables indicate. 



62 A TEXT-BOOK OF MATERIA MEDICA. 



PHARMACEUTICAL PREPARATIONS. 

Preparations made by the pharmacist are called pharmaceutical 
preparations. Nearly one-half of the articles of the United States 
Pharmacopoeia are pharmaceutical ; formulas being given for their 
preparation, they are intended to be made in the pharmacy. A 
still greater number are unofficial, being chiefly such as are made 
according to the formulas or prescriptions of eminent medical 
practitioners and teachers. Such of the latter as have attained 
general use and proved of value have been incorporated in the 
National Formulary, a work published under the direction of the 
American Pharmaceutical Association. 

The importance of having a uniform standard for the prepara- 
tion and strength of this class of medicines has long been recog- 
nized, instead of the variation in strength and product inseparable 
from a number of manufactures with the consequent multiplicity in 
processes and formulas. These preparations of the National For- 
mulary, designated N. F., are included in this work, following the 
official preparations (U. S. P.) of the classes to which they belong. 

The pharmaceutical preparations may be divided as follows : 

I. Solutions. 

II. Liquid Mixtures — Internal. 

III. Extractive Preparations — Liquid and Solid. 

IV. Mixtures of Solids — Internal. 

V. Mixtures for External Use — Liquids and Solids. 

These groups are each divided into a number of Classes, each 
class having a distinct Latin title by which its members, or indi- 
vidual preparations, are officially designated and alphabetically 
arranged in the U. S. P. In addition to the Latin and English 
titles, each class is also known by an English name, besides various 
synonyms. There are altogether 34 of these Classes official, 
besides a number unofficial. Official 

number. 

I. The Solutions are divided, according to the charac- 
ter of the solvent, into — 

Aqueous: Aquae — Waters 19 

Liquores — Liquors (solutions proper) 24 

Alcoholic: Spiritus — Spirits 25 

Elixiria — Elixirs 2 

Vina — Wines (by solution) 3 



PHARMACEUTICAL PREPARATIONS. 63 

Official number. 

Saccharine: Syrupi — Syrups 32 

Mellita — Honeys 2 

Glycerin: Glycerita — Glycerites 6 

II. The Liquid Mixtures — Internal : 

Misturae — Mixtures (proper) 4 

Emulsa — Emulsions 4 

III. Extractive Preparations : 

Liquid : 

Aqueous : Mucilagines — Mucilages 4 

Infusa — Infusions 4 

Decocta — Decoctions 2 

Acetous : Aceta — Vinegars 2 

Vinous: Vina — Wines 5 

Alcoholic: Tincturae — Tinctures 71 

Extracta Fluida — Fluid Extracts 89 

Solid : 

Alcoholic: Extracta — Extracts 33 

Abstracts (unofficial). 

Resinae — Resins 3 

Semi-liquid : 

Ethereal: Oleoresinae — -Oleoresins 6 

IV. Mixtures of Solids — Internal : 

Pulveres — Powders 9 

Tritu ratio — Trituration 1 

Sales effervescentes — Salts, effervescent .... 4 

Confectiones — Confections 2 

Trochisci — Troches 15 

Massae — Masses 3 

Pilulae— Pills 15 

V. Mixtures of Solids — External : 

Liquid: Linimenta — Liniments 9 

Oleata — Oleates 3 

Collodia — Collodions 4 

Solid: Unguenta — Ointments 23 

Cerata — Cerates 6 

Suppositoria — Suppositories 1 

Emplastra — Plasters 13 

Chartae — Papers 2 

Total 453 



64 A TEXT-BOOK OF MATERIA MEDIC A. 

AQILE MEDICATE— MEDICATED WATERS. 

The Medicated Waters are solutions of volatile substances in 
Water. They comprise (i) the Aromatic Waters and (2) the 
Chemical Waters. 

The Aromatic Waters are made by dissolving the volatile oils 
of their respective drugs, or distilling the latter with Water ; two 
Waters are saturated solutions of other liquids than volatile oils — 
viz. Aqua Chloroformi and Aqua Creosoti. 

The following are official : 

Contains Cc. in 100 Cc, 
Aqua — or percentage by volume. 

Amygdalae Amarae bitter almond oil 0.1 

Anisi . anise oil 0.2 

Aurantii Florum Fortior ........ saturated 

Aurantii Florum of the above 50. 

Camphorae camphor 0.8 

Chloroformi 1 chloroform 0.5 

Cinnamomi cinnamon oil 0.2 

Creosoti creosote 1. 

Fceniculi fennel oil 0.2 

Menthae Piperitae peppermint oil 0.2 

Menthae Viridis spearmint oil 0.2 

Rosae Fortior saturated 

Rosae of the above 50. 

The Chemical Waters are solutions of gases in Water. The fol- 
lowing are official : 

Contains gas, percent- 
Aqua — age by weight. 

Ammoniae NH 3 10 

Ammonias Fortior NH 3 28 

Chlori CI 0.4 

Hydrogenii Dioxidi (Hydrogen Peroxide) . . . H 2 2 3. 

LIQUORES— SOLUTIONS. 

The Solutions (also termed So/utio, -nes, Lat.) are solutions of 
non-volatile substances in Water. 

The official Solutions are all solutions of inorganic salts. They 
are made either by simple solution (dissolving the particular salt in 

1 Chloroform Water, aside from its medicinal properties, is an efficient preservative 
agent, and forms a good solvent in place of water for preparing solutions intended to be 
kept free from micro-organisms, as, for example, those for hypodermic use. 



PHARMACEUTICAL PREPARATIONS. 65 

Water) or by chemical solution (reacting upon different substances, 
and obtaining the newly-formed salt in solution in the Water). The 
following 24 are official : 

The Arsenic Solutions : these are all of the same strength — 
viz. 1 per cent. ; 10 minims (0.6 Cc.) represent ^ grain (0.006 Gm.) 
of arsenic, the usual dose : 

Percentage 
Liquor — or Gm. in 100 Cc. 

Acidi Arsenosi acid, arsenous 1. 

Arseni et Hydrargyri Iodidi arsenic iodide 1. 

(Donovan's Solution). mercuric iodide 1. 

Potassii Arsenitis . . . potas. bicarb. 2 ; acid, arsenous 1. 

(Fowler's Solution) tinct. lavender comp. 3. 

Sodii Arsenatis sodium arsenate 1. 

The Alkaline Salt Solutions, prepared by saturating an organic 
acid with an alkaline carbonate or bicarbonate, furnishing an agree- 
able and refreshing potion (also designated Saturatio, Potio, Lat.) 
charged with Carbonic Acid Gas. The dose is from 2 to 4 fluid- 
drachms (8-15 Cc), except Liq. Magnesiae -Citratis : 

Liquor — Gm. in 100 Cc. 

Ammonii Acetatis (Spiritus Mindererus) ammon. carb. 5. 

acid, acetic, dil. 100. 

Ferri et Ammonii Acetatis . . . liquor ammon. acet. 20. 

(Basham's Mixture), acid, acetic, dil. 3. ; tr. ferri chlor. 2. 

elix. arom. 12; glycerin 10; aqua ad 100. 

Magnesii Citratis . . . magnes. carb. 15.; acid, citric. 30. 

potas. bicarb. 25.; syrup, 

acid, citric. 60 Cc; aqua ad 350. 

Potassii Citratis (Neutral Mixture) . . potass, bicarb. 8. 

acid, citric. 6.; aqua ad 100. 

The Iron Solutions, containing ferric salts in the following pro- 
portions by weight : 

Gm. in 100, or 
Liquor — percentage by weight. 

Ferri Acetatis ferric acetate 31. 

Ferri Chloridi ferric chloride 37.8 

Ferri Citratis ferric citrate 42.5 

Ferri Nitratis ferric nitrate 6.2 

Ferri Subsulphatis (Monsel's) . . ferric subsulphate 43.7 

Ferri Tersulphatis ferric sulphate 28.7 



66 A TEXT-BOOK OF MA TERIA MEDICA. 

These are mostly used in producing other Iron preparations and 
compounds, particularly the Tincture of Ferric Chloride, the Ferric 
Hydrate (arsenical antidote), and the scaled salts of iron. 

The Alkali Solutions : 

Percentage by vol. 
Liquor — or weight. 

Calcis (Lime Water) calcium hydrate 0.17 

Potassae potassium hydrate 5. 

Sodae sodium hydrate 5. 

Sodae Chloratae (Labarraque's) chlorine 2.6 

The Solutions of Metallic Compounds ; all but that of Iodine 
are used only externally : 

Percentage by vol. 
Liquor — or weight. 

Iodi Compositus (Lugol's Solution) . . potass, iodid. 10. 

iodine 5. 

Hydrargyri Nitratis mercuric nitrate 60. 

Plumbi Subacetatis lead subacetate 25. 

Plumbi Subacetatis Dilutus .... of above solution 3. 

(Lead Water) distilled water to I OO. 

Sodii Silicatis sodium silicate 50. 

Zinci Chloridi zinc chloride 50. 



Unofficial Liquors of the National Formulary. 
Liquor — 

Acidi Phosphorici Compositus (Acid Phosphates). 
Alumini Acetatis (Alumini Acetici, Ph. Ger.). — Contains 8 

per cent, of basic Aluminum Acetate. 
Alumini Acetico-tartratis. — Contains about 50 per cent. 

of dry, so-called Aluminum Acetico-tartrate, which may 

be obtained by evaporating the solution. 
Auri et Arseni Bromidi. — Ten minims contain -£% grain 

(0.002 Gm.) of Tribromide of Gold and -^ grain (0.004 Gm). 

of Tribromide of Arsenic. 
Bismuthi. — Each fluidrachm (4 Cc.) represents 1 grain (0.06 

Gm.) Bismuth and Ammonium Citrate. 
Bromi (Smith's Solution of Bromine). — Bromine, 20 per cent.; 

Potassium Bromide, 10 per cent. ; Water. 
Calcis Sulphurate (Solution of Oxysulphuret of Calcium ; 

Vlemingkx's Solution or Lotion). 



PHARMACEUTICAL PREPARATIONS. 6j 

Liquor — 

Cupri Alkalinus (Fehling's Solution). 

I. The Copper Solution. 

Copper Sulphate, pure grains 505 . . 34,639 Gm. 

Distilled Water . . enough to make fluidounces 16 . . 500 Cc. 
II. The Alkaline Solution. 

Potassium and Sodium Tartrate . . grains 252 . . 173 Gm. 

Soda (U. S. P.) troy ounces 2 . . 60 Gm. 

Distilled Water . . enough to make fluidounces 16 . . 500 Cc. 

Keep both solutions, separately, in small well-stoppered vials, in a cool and 
dark place. For use, mix exactly equal volumes of both solutions by pouring 
the copper solution into the alkaline solution. Ten Cc. of the mixture prepared 
by metric weight and measure correspond to 0.05 Gm. of glucose. Of the mix- 
ture prepared by apothecaries' weight and measure, 210 minims correspond to 
I grain of glucose. 

Electropoeicus (Battery-fluid). 

A. For the Carbon and Zinc Battery . — I. (For ordinary use). — Potassium Bi- 
chromate, in powder, 6 troy ounces (180 Gm.) ; Sulphuric Acid, commercial, 
6 fluidounces (180 Cc.) ; Water, cold, 48 fluidounces (1400 Cc). — II. (For use 
with the galvano- cautery). — Sodium Bichromate, in powder, 6^ troy ounces 
(185 Gm.) ; Sulphuric Acid, commercial, 14 fluidounces (420 Cc); Water, 
cold, 48 fluidounces (1400 Cc). 

Pour the Sulphuric Acid upon the powdered Bichromate and stir the mix- 
ture occasionally during one hour. Then slowly add the Water. Sodium Bi- 
chromate is more soluble than the Potassium Salt, and also much cheaper. 
When it cannot be obtained, the Potassium Salt may be substituted for it, 
weight for weight. 

B. For the Leclanchk Battery. — Ammonium Chloride, 6 troy ounces (180 
Gm.) ; Water, enough to make 20 fluidounces (600 Cc.) ; dissolve the Salt in 
the Water. 

Ferri Oxysulphatis (Oxysulphate of Iron). 

Ferri Protochloridi (Solution of Ferrous Chloride). — Each 
fluidrachm (4 Cc.) represents about 20 grains (1.3 Gm.) of 
Protochloride of Iron (ferrous chloride). 

Hydrargyri et Potassii Iodidi (Solution of Iodide of Mer- 
cury and Potassium ; Channing's Solution). — Red Mercuric 
Iodide, 72 grains (5.0 Gm.) ; Potassium Iodide, 56 grains 
(3.8 Gm.); in Distilled Water, 16 fluidounces (450 Cc). 

Hypophosphitum. — Each fluidrachm (4 Cc.) contains 2 grains 
(0.12 Gm.) of Calcium Hypophosphite, \\ grains (0.75 Gm.) 
of Sodium Hypophosphite, and 1 grain (0.06 Gm.) of Po- 
tassium Hypophosphite. 

Iodi Carbolatus (Boulton's Solution ; " French Mixture "). — 



68 A TEXT-BOOK OF MATERIA MEDICA. 

Liquor — 

Comp. Tincture of Iodine, no minims (7 Cc); Carbolic 
Acid, 40 grains (3.0 Gm.) ; Glycerin, 2\ fluidounces (100.0 
Cc); in 16 fluidounces (450 Cc). 

Iodi Causticus (Iodine Caustic ; Churchill's Iodine Caustic). 
— Iodine, I troy ounce (31 Gm.); Potassium Iodide, 2 troy 
ounces (63 Gm.) ; in Water, 4 fluidounces (120 Cc). 

Magnesii Bromidi. — Each fluidounce (30 Cc) contains about 
7 grains (0.5 Gm.) of Magnesium Bromide. 

Morphine Citratis. — Each fluidrachm (4 Cc.) contains 2 
grains (0.12 Gm.) of Morphine in the form of citrate. 

Morphine Hypodermicus (Magendie's Solution of Morphine). 1 
— 1 6 grains ( 1 Gm.) Morphine Sulphate to 1 fluidounce (30 Cc). 

Pancreaticus (Pancreatic Solution). — Each fluidrachm (4 Cc) 
represents 1 grain (0.06 Gm.) of Pancreatin, effectually pre- 
served in Glycerin and a little Alcohol. 

Pepsini Aromaticus. — Each fluidrachm (4 Cc.) represents 
1 grain (0.06 Gm.) of Pepsin. 

Phosphori (Thompson's Solution of Phosphorus). — Each fluid- 
drachm (4 Cc.) contains about -^ grain (0.0025 Gm.) of 
Phosphorus, preserved in Absolute Alcohol and Glycerin. 

Picis Alkalinus (Tar, Alkaline). 

Potass^e Chlorate (Solution of Chlorinated Potassa ; Javelle 
Water). — An effective and popular disinfectant. 

Potassii Arsenatis et Bromidi (Liquor Arsenii Bromidi; 
Clemens' Solution). — This solution contains an amount of 
Arsenic in combination corresponding to about I percent, 
of Arsenous Acid. 

The title " Solution of Bromide of Arsenic " (Liquor Arsenii Bromidi), which 
is often applied to Clemens' Solution or similar preparation, is a misnomer, 
since bromide of arsenic cannot exist, as such, in presence of water, but is 
split up into hydrobromic and arsenous acids. The proportions of the ingre- 
dients, in the formula above given, have been adjusted as closely as practicable, 
so as to yield definite compounds — viz. arsenate and bromide of potassium. 

Saccharini (Solution of Saccharin). — Each fluidrachm repre- 
sents 4 grains of Saccharin. 

Intended to be used for sweetening liquids and solids when the use 
of sugar is objectionable, or when a sweet taste is to be imparted to a liquid 
without increasing its density. 

1 Particular care should be taken in prescribing and dispensing this solution, so that 
it may not be mistaken for the so-called United States Solution of Morphine (Liquor 
Morphige Sulphatis, U. S. P. 1870), containing only I grain of Sulphate of Morphine 
in each fluidounce, which is still occasionally used. 



PHARMACEUTICAL PREPARATIONS. 69 

Liquor — 

Seriparus (Liquid Rennet). 

If this liquid is to be used merely for curdling milk, without separating the 
whey as a distinct layer, it should be added to the milk, previously warmed 
to a temperature of about 35 C. (95 F.), and the mixture should then be set 
aside undisturbed until it coagulates. If the whey is to be separated, the 
Liquid Rennet should be added to the milk while cold, and the mixture 
heated to about 35 C. (95 F.), but not exceeding 40 C. (104 F.). One part 
of the liquid should coagulate between 200 and 300 parts of cows' milk. 

Liquor Sodii Arsenatis, Pearson. — This Solution contains 
about 3^ per cent, of anhydrous Sodium Arsenate. 

This preparation should not be confounded with the Liquor Sodii Arsenatis 
of the U. S. P., which is ten times stronger than the above. Pearson's Solu- 
tion is official in the French Pharmacopoeia, under the title Solute d'Arse- 
niate de Soude (or Solution Arsenicale de Pearson). 

Sodii Boratis Compositus (Dobell's Solution). — Sodium 
Borate and Sodium Bicarbonate, each 120 grains (8.0 Gm.); 
Carbolic Acid, 24 grains (1.5 Gm.); Glycerin, \ fluidounce 
(15 Cc); in Water, 16 fiuidounces (450 Cc). 

Sodii Carbolatis (Phenol Sodique). — Carbolic Acid, 50 per 
cent. ; Soda, 3 per cent. ; in Water. 

Sodii Citratis. — Saturatio (Potio Riveri, Ph. Ger.). — Citric 
Acid, 150 grains (10.0 Gm.) ; Sodium Bicarbonate, 190 
grains (12.5 Gm.) ; in Water, 16 fiuidounces (450 Cc). 

Sodii Citro-tartratis (Effervescing Saline Water). — Sodium 
Bicarbonate, Tartaric Acid, Citric Acid, Syrup, and Water, 
in about the same proportions as in Solution of Magnesium 
Citrate, for which it is a cheaper substitute. 

Sodii Oleatis (Oleate of Sodium). — Intended to be used in 
the preparation of oleates. 

Strychnine Acetatis (Hall's Solution of Strychnine). — Each 
fluidrachm (4 Cc.) contains \ grain (0.008 Gm.) Strychnine 
Acetate. 

The Ph. Br. directs a Liquor Strychninae Hydrochloratis (with synonym, 
Liquor Strychniae) which is much stronger, and should not be confounded 
with the above preparation. It should never be dispensed unless expressly 
designated. 

Zinci et Ferri Compositus (Deodorant Solution). — A com- 
bination of Sulphates of Zinc and Iron, Naphthol, Oil of 
Thyme, and Hypophosphorous Acid, in Water. 

Used as a simple deodorant and antiseptic for common domestic use when 
it is unnecessary or impracticable to employ more powerful agents. 



70 A TEXT-BOOK OF MATERIA MEDICA. 

When a deodorant solution is required for purposes where iron is objection- 
able — as, for instance, when woven fabrics are to be steeped in it — the follow- 
ing preparation may be employed : 

Liquor Zinci et Alumini Compositus, in which the Iron Sulphate is replaced 
by Aluminum Sulphate. 

Liquor — 

Zingiberis (Essence of Ginger). — A 25 per cent, preparation 
of Ginger for flavoring aqueous mixtures. 

SPIRITUS— SPIRITS. 

The Spirits are solutions of volatile substances in Alcohol. 
They comprise (1) the Natural Spirits ; (2) the Aromatic Spirits, 
or so-called " Essences ; " and (3) the Medicinal Spirits. 

The Natural Spirits are produced by distillation, and include : 

Spiritus Frumenti (Whiskey), containing Alcohol 50-58 per 

cent, by volume. 
Spiritus Vini Gallici (Brandy), containing Alcohol 46-55 per 

cent, by volume. 
Spiritus Juniperi Comp. (Gin), containing Alcohol 60-70 per 

cent, by volume. 

The Aromatic Spirits are made by dissolving the respective oils 
or aromatic principles in (deodorized) Alcohol : 

Cc. in 100 Cc, 
Spiritus — or percentage by vol. 

Amygdalae Amarae (water 20) . . bitter almond oil 1 . 

Anisi (alcohol deod.) anise oil 10. 

Aurantii " orange oil 5. 

Aurantii Comp. (alcohol deod.) .... orange oil 20. 
oils, anise 0.5, coriander 2 ; lemon oil 5. 

Camphorae camphor 10. 

Cinnamomi cinnamon oil 10. 

Gaultheriae wintergreen oil 5. 

Juniperi juniper oil 5. 

Lavandulae (alcohol deod.) lavender oil 5. 

Limonis lemon peel 5 ; oil 5. 

Menthae Piperitae peppermint herb I ; oil 10. 

Menthae Viridis . . . • . . spearmint herb 1 ; oil 10. 

Myrciae (Bay Rum) water 38; oil of bay 0.8 

oils, orange, pimenta, each 0.05 
Myristicae . . nutmeg (vol.) oil 5. 

These are chiefly used for flavoring purposes ; some are used 



PHARMACEUTICAL PREPARATIONS. 71 

medicinally as aromatic stimulants and carminatives in doses of 
from 15-30 minims (1-2 Cc.) ; Spiritus Amygdalae Amarae con- 
tains Hydrocyanic Acid, and is never used internally except in 
very small quantities as a flavor. 

The Medicinal Spirits are made by solutions of the medicinal 
substance in Alcohol. 

The following are official : „ . „ 

& Cc. in 100 Cc, 

Spiritus — or percentage by vol. 

Athens ether (C 2 H 5 ) 2 32.5 

^Etheris Comp. (Hoffmann's Anodyne) . ethereal oil 2.5 

ether 32.5 

By weight. 

^Etheris Nitrosi (Sweet Spirit of Nitre) . ethyl nitrite 4. 

Ammoniae ammonia gas 10. 

Ammonias Aromaticus . . water 14; ammonia water 9. 

ammonia carb. 3.4 

oils, lavender, nutmeg, each o. 1 ; lemon oil 1. 

Chloroformi chloroform 6. 

Glonoini nitroglycerin I. 

Phosphori absolute alcohol, phosphorus 0.12 

The dose of these Spirits is from 30 to 60 minims (2 to 4 Cc. ; 
about 75 to 150 "drops"), except the Ammonia Spirit, used only in 
the preparation of Liniments (externally), and that of Phosphorus, 
which is for the preparation of the Elixir. 

Unofficial Spirits of the National Formulary. 
Spiritus — 

Acidi Formici (Spirit of Ants, Ph. Ger.). — A solution of 
3 per cent, of Formic Acid in Water and Alcohol. 

Ophthalmicus (Alcoholic Eye-wash). — A solution of 10 min- 
ims (0.6 Cc.) Oil of Lavender and 30 minims (2 Cc.) Oil 
of Rosemary, in Alcohol 1 fluidounce (30 Cc). 

Saponatus (Spirit of Soap). 

Sinapis (Spirit of Mustard, Ph. Ger.). — A solution of 2J per 
cent, of Volatile Oil of Mustard in Alcohol. 

SYRUPI— SYRUPS. 

Syrups are nearly saturated Solutions of Sugar in Water, in 
which aromatic or medicinal substances are dissolved. 



72 A TEXT-BOOK OF MATERIA MEDIC A. 

The official Syrup, Syrupus, contains 65 per cent, by weight, 
85 per cent, by volume, of Sugar (about 7 pounds, average, in 
I gallon) : with a smaller proportion of Sugar the syrup undergoes 
fermentation (spoils). 

The " Medicated Syrups " contain less sugar, owing to the solu- 
tion of the medicinal substances, which usually reduce the solubility 
of the sugar in the liquid from which the syrup is prepared. 
Syrups should be kept in a cool place, in cork-stoppered bottles, in 
order to preserve them. 

The thirty-two official Syrups are made by different methods : 
by solution, or mixing the medicinal substance with the syrup; 
by dissolving the Sugar in the medicinal solution ; by extraction 
from the drug; and by chemical reaction and solution. 

They may be divided into (1) the aromatic or adjuvant syrups, 
and (2) the medicinal syrups, comprising (a) those made from 
extractive drugs, including alteratives, astringents, cathartics, and 
expectorants, and (b) those made from chemicals, either by simple 
solution or by chemical reaction and solution, including the hypo- 
phosphites, iron, and other tonics. 

The Aromatic or Adjuvant Syrups are mostly used as additions 
to, or vehicles of, liquid mixtures containing Bromides, Iodides, 
Phosphates, or similar salts of disagreeable saline taste, desirable 
to disguise. 

The following are official: 

Cc. in 100 Cc, 
Syrupus — or percentage by vol. 

Acaciae mucilage acacia 25. 

Acidi Citrici spir. lemon, 1 ; acid, citric I. 

Althaeae marshmallow 5. 

Amygdalae . . (bitter almond 4, sweet almond 14) 18. 

orange flower water 10. 

Aurantii orange, fresh exterior rind 5. 

Aurantii Florum orange flower water 50. 

Rubi Idaei raspberry juice (fresh) 40. 

Tolutanus tolu balsam 1. 

Zingiberis fluid extract of ginger 3. 

The Extractive Syrups are often made by mixing the Fluid 
Extract of the respective drugs with Syrup. 

Tinctures and Fluid Extracts of resinous drugs often precipitate 



PHARMACEUTICAL PREPARATIONS. 73 

when mixed with Syrups and aqueous solutions. In order to fur- 
nish clear mixtures it is therefore sometimes necessary to mix the 
extractive preparation with Water, clarify the mixture by filtration, 
and dissolve the sugar in the filtered liquid. 

The following are official : „ 

° Gm. of Drug 
Syrupus — in 100 Cc. 

Allii vinegar of garlic 20. 

Ipecacuanhae fl. ext ipecac 7. 

Krameriae fl. ext. rhatany 45. 

Lactucarii tinct. lactucarium 10. 

Picis Liquidae glycerite, tar 7.5 

Pruni Virginianae wild cherry 15. 

Rhei fl. ext. rhubarb 10. 

Rhei Aromaticus tinct. rhubarb, arom. 15. 

Rosae fl. ext. red rose 12.5 

Rubi *. . fl. ext. blackberry bark 25. 

Sarsaparillae Comp fl. ext. sarsaparilla 20. 

fl. ext. glycyrrh., senna, each 1.5 

oils, sassafras, anise, gaultheria, each 0.0 1 

Scillae vinegar of squill 45. 

Scillae Comp fl. exts. squill, senega, each 8. 

(Coxe's Hive Syrup) . . antimony and potass, tart. 0.2 

Senegae fl. ext. senega 20. 

Sennae oil coriander 0.5 ; senna 25. 

The Chemical Syrups are an elegant class of preparations in 
which the taste of the medicinal agents is greatly modified. They 
do not keep well unless put up in small bottles completely filled, 
ready for dispensing. Except the Syrup of Iodide of Iron, which 
is best preserved in bottles exposed to light, they should be kept 
in a cool and dark place. 

The Syrup of Iron, Quinine, and Strychnine Phosphates (Easton's 
Syrup, Ph. Br.) is almost identical with the well-known unofficial 
Elixir of that name. It contains fa grain of Strychnine in 80 min- 
ims (1 mg. in 5 Cc); the formula of the U. S. P. 1880 yielding a 
Syrup nearly three times as strong, care should be observed that 
the preparations of the two formulas be not accidentally confused 
with each other. A somewhat similar preparation is the Syrupus 
Hypophosphitum Compositus of the N. F. 



74 A TEXT-BOOK OF MA TERIA MEDICA. 

The following are official: Percentage. 

Gm. or Cc. 
Syrupus — in 100. 

Acidi Hydriodici .... . acid, hydriodic, by weight I. 

Calcii Lactophosphatfs . . . calcium lactophosphate I . 

Calcis lime (calcium saccharate) I. 

Ferri Iodidi ferrous iodide, by weight io. 

Grains Percent- 
in i fluid- age by 
drachm (4. Cc). vol. 

Ferri, Quininse et Strychninae Phosphatum: 

ferric phosphate, soluble \\ 2. 

quinine sulphate 2 3. 

strychnine -^ 0.02 

acid, phosphoric 3 4.8 

Hypophosphitum . . . calcium hypophosphite 3 4.5 

potassium and sodium hypophosphites, each I 1.5 

spirit lemon 0.5 ; acid hypophos. dil. 0.2 

Hypophosphitum cum Ferro . . ferrous lactate I. 

with potass, citrate 1, in syrup hypophosph. 

Unofficial Syrups of the National Formulary. 

Unless otherwise stated, the dose is 1 to 2 fluidrachms or tea- 
spoonfuls (4-8 Cc). 

Syrupus — 

Act^e^: Compositus (Cimicifuga or Black Cohosh). — Contain- 
ing 2\ grains (0.15) each of Cimicifuga and Wild Cherry, 
1 \ grains (0.07) Glycyrrhiza and Senega, and f grain (0.04) 
Ipecac in each fluidrachm (4 Cc). 

Asari Compositus (Canada Snake Root).-— Each fluidrachm 
(4 Cc.) represents ^\ grains (0.2) of Asarum. 

Calcii Chlorhydrophosphatis (Chlorhydrophosphate of 
Lime). — Each fluidrachm (4 Cc) contains 1 grain (0.06) of 
Calcium Phosphate. 

Calcii et Sodii Hypophosphitum (Hypophosphite of Lime 
and Soda). — Each fluidrachm (4 Cc.) contains 2 grains (o. 1 3), 
each, of Hypophosphites of Calcium and Sodium. 

Calcii Hypophosphitis (Hypophosphite of Lime). — Each 
fluidrachm (4 Cc) contains 2 grains (0.13) of Calcium Hypo- 
phosphite. 

Calcii Iodidi (Iodide of Calcium). — Each fluidrachm (4 Cc.) 
contains about 5 grains (0.3) of Calcium Iodide. 



PHARMACEUTICAL PREPARATIONS. 75 

Syrupus — 

Calcii Lactophosphatis cum Ferro (Lactophosphate of 
Lime with Iron). — Each fluidrachm (4 Cc.) contains \ grain 
(0.03) of Lactate of Iron and about \ grain (0.015) °f 
Calcium Lactate (or about ■§ grain (0.02) of so-called Lacto- 
phosphate of Calcium). 

Chondri Compositus (Irish Moss). — Containing 1 grain (0.06) 
each of Squill and Senega, -^ grain (0.004) eacn of Ipecac 
and Irish Moss, and i-| minims (0.1) Tincture Opium Camph. 
to each fluidrachm (4 Cc). 

Cinnamomi (Cinnamon, Ph. Ger.). — Chiefly used for flavoring. 

Codeine. — Containing \ grain (0.03) Codeine Sulphate in 
each fluidrachm (4 Cc). The Syrup of the French Codex 
is about one-fourth this strength. 

CoFFEiE (Coffee). — Containing 15 grains (1.) of the choicest 
Coffee (Java and Mocha) in fluidrachm (4 Cc) ; an elegant 
vehicle for Quinine and addition to nauseous mixtures. 

Eriodictyi Aromaticus (Yerba Santa; Syrupus Corrigens). 
— Chiefly intended as a vehicle for disguising the taste of 
Quinine and other bitter substances. 

Ferri Arsenatis. — Each fluidrachm (4 Cc.) contains about 
-^q grain (0.00 1 ) of Arsenate of Iron (ferric). 

Ferri Bromidi (U. S. P., '8o). — Containing 10 per cent, of 
Ferrous Bromide. 

Ferri Citro-iodidi (Tasteless Syrup of Iodide of Iron). — 
Each fluidrachm (4 Cc.) contains an amount of Iron corre- 
sponding to about 3.6 grains (0.25) of Ferric Iodide. The 
official Syrupus Ferri Iodidi contains about 8 grains (0.5) 
of Ferrous Iodide (Protiodide of Iron) in each fluidrachm 

(4 Cc). 

Ferri et Mangani Iodidi (Iodide of Iron and Manganese). — 
Each fluidrachm (4 Cc.) contains 6 grains (0.4) of Iodide 
of Iron (ferrous) and 3 grains (0.2) of Iodide of Manganese. 

Ferri Hypophosphitis (Hypophosphite of Iron). — Each fluid- 
drachm (4 Cc.) contains 1 grain (0.06) of Hypophosphite of 
Iron (ferric). 

Ferri Lactophosphatis (Lactophosphate of Iron). — Each 
fluidrachm (4 Cc.) contains 1 grain (0.06) of Lactate of 
Iron, or about i| grains (0.1) of so-called Lactophosphate 
of Iron. 

Ferri Protochloridi (Ferrous Chloride). — Each fluidrachm 



76 A TEXT-BOOK OF MATERIA MEDIC A. 

Syrupus — 

(4 Cc.) contains about 1 grain (0.06) of Protochloride of 
Iron. 

Ferri Saccharati Solubilis (Soluble Saccharated Iron; 
Saccharated Oxide of Iron, Ph. Ger.), — Each 75 minims (5 
Cc.) represents approximately 1 grain (0.06) of Metallic 
Iron, or 3 grains (0.2) of Oxide of Iron. 

Glycyrrhiz,e (Liquorice). — Each fluidrachm (4 Cc.) repre- 
sents 30 grains (2.) of Glycyrrhiza. 

Hypophosphitum Compositus. — Each fluidrachm (4 Cc.) con- 
tains 2 grains (0.12) of Calcium Hypophosphite, 1 grain 
(0.06), each, of the Hypophosphites of Potassium and 
Sodium, \ grain (0.008), each, of the Hypophosphites of 
Iron and Manganese, ^ grain (0.004) of Quinine Hydro- 
chlorate, and 1 \ minims (0.01) of Tincture of Nux Vomica. 

This Syrup should not be confounded with the official Syrupus Hypo- 
phosphitum (Syrup of the Hypophosphites : Calcium, Sodium, and Potassium). 
It is intended to replace a well-known proprietary article, for which it has been 
found by many physicians to be a satisfactory substitute. It is uniform in com- 
position and more stable and elegant than the patent article. 

Ipecacuanha et Opii (Syrup of Dover's Powder). — Each 
fluidrachm (4 Cc.) represents 5 grains (0.3) of Dover's Pow- 
der, or \ grain (0.03), each, of Ipecac and Opium. 

Mann^e (Syrup of Manna, Ph. Ger.). 

Morphine Compositus. — A preparation sometimes dispensed 
as Jackson's Pectoral Syrup, but, as it differs in essential 
particulars, the N. F. recommends that this preparation be 
dispensed only when expressly designated under this title. 
Each fluidrachm (4 Cc.) contains \ grain (0.008) Ipecac, 
5 grains (0.3) Senega, 1 grain (0.06) Rhubarb, and -^ 
grain (0.002) Morphine, with Oil of Sassafras. 

Morphine Sulphatis (Syrup of Morphine). — Each fluid- 
drachm (4 Cc.) contains \ grain (0.008) of Sulphate of 
Morphine. 

Papaveris (Poppy, Ph. Br. ; Diacodii, Ph. Ger.). — Similar to the 
preceding, but considerably weaker. 

Pectoralis (Jackson's Pectoral Syrup). — Each fluidrachm 
(4 Cc.) contains -^ grain (0.002), each, of Morphine and Oil 
of Sassafras. 

Phosphatum Compositus (Chemical Food). — Each fluidrachm 
(4 Cc.) contains about 2 grains (0.12) of Phosphate of 



PHARMACEUTICAL PREPARATIONS. 77 

Syrupus — 

Calcium, 1 grain (0.06), each, of the Phosphates of Iron 
and Ammonium, and smaller quantities of the Phosphates 
of Potassium and Sodium. 

Pini Strobi Compositus (White Pine Compound). — A com- 
bination of White Pine, Wild Cherry, Spikenard, San- 
guinaria, Chloroform, and Morphine, -£% grain (0.002) in a 
fluidrachm. 

Rhamni Cathartics (Buckthorn Berries ; Syrupus Spinae 
Cervinae, Ph. Ger.). 

Rubi Aromaticus (Blackberry, Aromatic). — A combination 
of Rubus, Cinnamon, Nutmeg, Cloves, and Allspice. 

Sanguinari^e (Bloodroot).— Each fluidrachm (4 Cc.) repre- 
sents 13 grains (0.8) of Sanguinaria. 

Senn^e Aromaticus (Senna, Aromatic). — Each fluidrachm 
(4 Cc.) represents 7J grains (0.5) of Senna, 3 grains (0.2) 
of Jalap, and 1 grain (0.06) of Rhubarb, with aromatics. 

Senn^e Compositus (Senna, Compound). — Each fluidrachm 
(4 Cc.) represents 8 grains (0.5) of Senna, 2 grains (0.12), 
each, of Rhubarb and Frangula. 

Sodii Hypophosphitis. — Each fluidrachm (4 Cc.) contains 
2 grains (0.12) of Sodium Hypophosphite. 

STiLLiNGiiE Compositus. — Each fluidrachm (4 Cc.) represents 
15 minims (1 Cc.) of Compound Fluid Extract of Stillingia. 

Oxymel Scill^e (Oxymel of Squill, Ph. Br.). — A preparation 
of Honey containing about 5 grains (.32 Gm.) of Squill in 
each fluidrachm (4 Cc). 

ELIXIRIA— ELIXIRS. 
Elixirs are a class of elegant preparations similar to wines or 
cordials, composed of Water, Sugar, Alcohol, and Aromatics. 

The medicinal substances are usually in such proportion that an 
ordinaiy dose may be contained in one or two teaspoonfuls (4 to 8 
Cc.) of the elixir. 

There are but two Elixirs official : Aromatic Elixir, which 
serves as a vehicle, and one medicinal, Elixir of Phosphorus. 

Elixir Aromaticum spirit of orange, comp. 12 Cc. 

mix with alcohol, deodorized, to make 250 Cc. 

to this solution add in several portions, agitating 

after each addition syrup 375 Cc. 

and in the same manner water 375 Cc. 



78 A TEXT-BOOK OF MATERIA MEDICA. 

mix the liquid with precipitated calcium phosphate 15 Gm. 
and filter, adding . . water 3 ; alcohol 1 ; to make 1000 Cc. 

This illustrates the method by which Elixirs are made. The 
medicinal ingredients are dissolved in the Water, or Alcohol, as 
indicated by their solubilities, before mixing the Alcoholic Solution 
of Oils with the Saccharine Solution. 

Elixir Phosphori : glyc. 5 5 ; anise oil 0.2 ; sp. phosph. 21 Cc. 
mix by agitation ; then add . aromatic elixir, to 100 Cc. 

This Elixir contains of phosphorus 25 mg. in 100 Cc, or -^ 
grain (1 mg.) in 1 fluidrachm (4 Cc), the ordinary dose. 

Some Salts and Fluid Extracts may be dissolved in or mixed 
with the Elixir itself. For example : 

Potassii Bromidi 10. 

Elixir Aromatici q. s. ad 100. Cc 

This contains 15 grains (1 Gm.) in 2\ fluidrachms (10 Cc), 6 
grains in 1 fluidrachm or teaspoonful. 

Elixirs of the Natio7ial Formulary. 
The value of pleasant vehicles to mask or modify the taste of 
bitter and nauseous drugs is recognized by every prescriber. The 
following Elixirs of the National Formulary have been carefully 
selected, and embrace the most effective combinations of adjuvants 
and aromatics for disguising the different drugs for which they are 
recommended : 

Elixir — 

Anisi ; a combination of Anethol, Fennel, and Bitter Almond. 
Curassao (Curasao Cordial) ; a combination of Curasao, Orris, 
and a little Citric Acid. 
Adjuvant Elixirs. — The following are intended as vehicles for 
Quinine and similar bitter substances, and as adjuvants for Tinctures 
and Fluid Extracts of bitter and resinous drugs, such as Cinchona, 
Cascara Sagrada, etc They all contain Glycyrrhiza, which, in the 
form directed in the N. F. (Russian Licorice Root, peeled), is most 
effective in masking the bitter taste of Quinine, when it is directed to 
be simply suspended in the mixture without the use of acid for 
effecting solution. Acids precipitate the glycyrrhizin and destroy 
its power of masking the bitter taste : 
Elixir— 

Adjuvans ; a combination of Orange, Wild Cherry, Glycyr- 
rhiza, Coriander, and Caraway. 

Except for the exhibition of Quinine this is the most effective of the adju- 
vant Elixirs. 



PHARMACEUTICAL PREPARATIONS. 79 

Elixir— 

Eriodictyi Aromaticum (Arom. Elixir Yerba Santa; Elixir 
Corrigens). — A solution of Yerba Santa in Comp. Elixir of 
Taraxacum, intended as a vehicle for Quinine and other 
bitter remedies. 

Glycyrrhiz^e (Elixir of Licorice) ; a solution of Licorice in 
Aromatic Elixir, the most effective vehicle for Quinine. 

Glycyrrhiz^e Aromaticum ; Elixir of Licorice, with the addi- 
tion of strong aromatics. 

Taraxaci Compositum ; an improved form of this well-known 
compound, useful as a mild adjuvant. 

Medicinal Elixirs. — These comprise the Elixirs mostly in use ; 
also, a number of preparations in which the prescriber will find 
satisfactory substitutes, designated by scientific titles and of 
definite strength and uniform composition, intended to replace 
various nostrums. 

Active Drug in 

1 Fluidrachm. 4. Cc. 
Elixir — grains. Gm. 

Acidi Salicylici 5 0.3 

Ammonii Bromidi 5 0.3 

Ammonii Valerianate 2 0.12 

The odor and taste of the salt being well 
covered by the addition of vanilla and a 
little chloroform. 
Ammonii Valerianatis et Quinine. — The 

above, with Quinine Hydrochlorate .... \ 0.015 
Apii Graveolentis (Celery Compound). — Con- 
taining Celery, Coca, Kola, and Viburnum, 

each 4 0.25 

Bismuthi. — Bismuth and Ammonium Citrate . 2 0.12 

Buchu y\ 0.5 

Buchu Compositum. — Buchu, Cubeb, Juniper, 

and Uva Ursi, combined 15 I. 

Buchu et Potassii Acetatis. — Elixir Buchu, 

with Potassium Acetate 5 0.3 

Caffeine. — Caffeine (in solution in Hydro- 

bromic Acid) I 0.06 

Calcii Bromidi 5 0.3 

Calcii Hypophosphitis 2 .12 



80 A TEXT-BOOK OF MATERIA MEDIC A. 

Active Drug in 

i Fluidrackm. 4 Cc. 
£lixir Grains. Gm. 

Calcii Lactophosphatis. — Calcium Lactate (in 

Phosphoric Acid) I 0.06 

Catharticum Compositum. — Each fluidrachm 
(4 Cc.) contains Senna 7^ grains (0.5) ; Podo- 
phyllum 4 grains (0.25) ; Leptandra and 
Jalap, each 3 grains (0.2) ; Rochelle Salts 
j\ grains (0.5); and Sodium Bicarbonate 1 
grain (0.06). The mixture should be shaken. 

Chloroformi Compositum. — A mixture of 
equal parts of Chloroform, Tincture of 
Opium, Spirit of Camphor, Aromatic Spirit 
of Ammonia, and Alcohol, flavored with Cin- 
namon. The old title, " Chloroform Pare- 
goric," is recommended to be abandoned for 
the above. Each fluidrachm (4 Cc.) contains 
I grain (0.06) of Opium and 1 1 minims (0.7) 
of' Chloroform. 

Cinchona (Elixir Calisaya). — This preparation 
is from the best Calisaya Bark, representing 
about 2 grains (0.12) in each fluidrachm (4 
Cc). It is preferable to preparations made 
from Quinine and the cheaper alkaloids in 
being a more agreeable and effective anti- 
periodic tonic. 

Cinchona et Ferri (Calisaya and Iron ; Fer- 

rated Elixir of Calisaya). — Phosphate of Iron . 2 0.12 

Cinchona et Hypophosphitum. — Calcium and 

Sodium Hypophosphites, each I 0.06 

Cinchona, Ferri, Bismuthi et Strychnine. 

— Phosphate of Iron 2 0.12 

Bismuth and Ammonium Citrate 1 0.06 

Strychnine Sulphate yj^ 0.0007 

Cinchon.e, Ferri et Bismuthi. — Phosphate of 

Iron 2 0.12 

Bismuth and Ammonium Citrate 1 0.06 

Cinchona, Ferri et Calcii Lactophosphatis. 

— Phosphate of Iron if 0.1 

Calcium Lactophosphate about 1 0,06 



PHARMACEUTICAL PREPARATIONS. 81 

Active Drug in 

i Fluidrachm. 4 Cc. 
Elixir — Grains. Gm. 

Cinchona, Ferri et Pepsini. — Phosphate of 

Iron 1} 0.1 

Pepsin I 0.06 

Cinchone, Ferri et Strychnine. — Phosphate 

of Iron 2 0.12 

Sulphate of Strychnine Y^^ 0.0007 

Cinchone, Pepsini et Strychnine. — Contain- 
ing smaller quantities of the Cinchona Alka- 
loids, Pepsin 1 grain (0.06), and Sulphate 

of Strychnine ^fa 0.0007 

Coce (Coca). — Leaves, Erythroxylon Coca . . 7J 0.5 
Coce et Guarane. — Coca and Guarana, of each 7 \ 0.5 
Corydalis Compositum. — Containing of Cory- 
dalis, Stillingia, Iris, and Xanthoxylum, 

combined 15 I. 

Potassium Iodide 3 0.2 

Digestivum Compositum. — Containing about 5 
grains (0.3) of Pulvis Digestivus in each 
fluidrachm (4 Cc). 

Eucalypti. — Eucalyptus Globulus 7} 0.5 

Euonymi (Wahoo). — Euonymus Atropurpureus 10 0.6 
Ferri Hypophosphitis. — Hypophosphite of 

Iron (ferric) I 00.6 

Ferri Lactatis 1 0.06 

Ferri Phosphatis. — Phosphate of Iron (U. S. P.) 2 o. 1 2 
Ferri Phosphatis, Cinchonidine et Strych- 
nine. — Phosphate of Iron 2 0.12 

Cinchonidine \ 0.03 

Sulphate of Strychnine ^fa 0.0007 

Ferri Phosphatis, Quinine et Strychnine. 
— Phosphate of Iron, 1 grain (0.06) ; Qui- 
nine \ 0.03 

Sulphate of Strychnine -g^ 0.00 1 

Ferri Pyrophosphatis 2 0.12 

Ferri, Quinine et Strychnine. — Ferric Chlo- 
ride, 1 grain (0.06) ; Quinine Hydrochlorate \ 0.03 

Sulphate of Strychnine -fa 0.0007 

Frangule (Buckthorn). — Rhamnus Frangula . 15 I. 



82 A TEXT-BOOK OF MATERIA MEDICA. 

Active Drug in 

i Fluidrachm. 4 Cc. 

Elixir — Grains. Gm. 

Gentians. 2 o. 1 2 

Gentians cum Tinctura Ferri Chloridi. — 

Tincture Citro-chloride of Iron ..... 5 0.3 
Gentians et Ferri Phosphatis (ferrophos- 

phated). — Phosphate of Iron 1 0.06 

Grindell^. — Grindelia Robusta ...... 4 0.25 

Guaran^j. — Paullinia Cupana 12 0.75 

Humuli j\ 0.5 

Hypophosphitum. — Calcium Hypophosphite . 3 0.2 

Sodium and Potassium Hypophosphites, each 1 0.06 
Hypophosphitum cum Ferro. — Calcium and 

Sodium Hypophosphite, each 1 0.06 

Potassium and Iron Hypophosphites, each . \ 0.03 

Lithii Bromidi 5 0.3 

LlTHII ClTRATIS 5 O.3 

Lithii Salicylatis 5 0.3 

Malti et Ferri. — Phosphate of Iron .... 1 0.06 

Malt Extract 15 1. 

Paraldehydi. — Paraldehyde 15 1. 

Pepsini. — Pepsin «... 1 0.06 

Pepsini, Bismuthi et Strychnine. — Elixir Pep- 
sin and Bismuth, and Strychnine .... y^-g- 0.0007 

Pepsini et Bismuthi. — Pepsin 1 0.06 

Bismuth and Ammonium Citrate 2 0.12 

Pepsini et Ferri. — Elixir of Pepsin and Tinc- 
ture Citro-chloride of Iron 5. 0.3 

Phosphori et Nucis Vomicae. — Elixir Phos- 
phorus, with Tincture Nux Vomica ... 2 0.12 

Picis Compositum. — A combination of Prunus 
Virginiana, Tolu, Methylic Alcohol, and Sul- 
phate of Morphine . -^ 0.0015 

Pilocarpi (Jaborandi). — Pilocarpus Selloanus . 4 0.25 

POTASSII ACETATIS 5 O.3 

Potassii Acetatis et Juniperi. — Elixir Potass. 

Acet. with Juniper 7J 0.5 

Potassii Bromidi. — Potassium Bromide, effect- 
ually masked in Adjuvant Elixir .... 10 0.6 
An Elixir half this strength has also been used. 



PHARMACEUTICAL PREPARATIONS. 83 

Active Drug in 

1 Fluidrachm. 4. Cc. 
Elixir — Grains. Gm. 

•Quinine Compositum (Red). — Sulphates of 
Quinine, \ grain (0.008), Cinchonidine and 

Cinchonine, each -^ 0.004 

Chiefly intended as a substitue for Elixir 
Cinchona when the administration of other 
constituents of the bark may be deemed ob- 
jectionable. 

Quinine et Phosphatum Compositum. — Qui- 
nine Sulphate \ 0.015 

Phosphate of Iron 1 0.06 

Calcium Lactophosphate \ 0.05 

Quinine Valerianates et Strychnine. — Va- 
lerianate of Quinine 1 0.06 

Sulphate of Strychnine Y^ 0.0007 

Rhamni Purshiane (Cascara Sagrada). — Rham- 
nus Purshiana, its bitterness effectually masked 
with Elixirs of Glycyrrhiza and Taraxacum 
Compound 15 1. 

Rhamni Purshiane Compositum (Laxative 

Elixir; Elixir Purgans). — Cascara Sagrada . 7f 0.5 

Senna and Juglans, each 5 0.3 

Associated with aromatics and correctives ; 
a most effective laxative in doses of from 1 to 2 
fluidrachms (4-8 Cc). 

Rhei. — Sweet Tincture of Rhubarb, represent- 
ing Rhubarb 2 J 0.15 

Rhei et Magnesia Acetatis. — Magnesium 

Acetate, 4 grains (0.25) ; Rhubarb 7i 0.$ 

Rubi Compositum (Blackberry Compound). — 
Blackberry Root, Galls, and Cinnamon (Sai- 
gon), in equal proportions, combined .... 10 0.6 
with smaller quantities of Cloves, Mace, and 
Ginger, in Blackberry Juice and Syrup. 

Sodii Bromidi. — Sodium Bromide, in Adjuvant 

Elixir 10 0.6 

Sodii Hypophosphitum 2 0.12 

Sodii Salicylatis (to be freshly prepared when 

required for use) 5 °-3 



84 A TEXT-BOOK OF MA TERIA MEDICA. 

Active Drug in 

i Fluidrachm. 4 Cc. 
Elixir — Grains. Gm. 

Stillingi^e Compositum. — Compound Fluid 

Extract of Stillingia, N. F . . . 15 1. 

Strychnine Valerianatis y^- 0.0007 

Turners (Damiana). — Turnera Aphrodisiaca . 10 0.6 
Viburni Opuli Compositum. — Viburnum Opu- 

lus, Aletris Farinosa, each ........ 5 0.3 

Trillium (Beth Root) . . . . 10 0.6 

Viburni Prunifolii (Black Haw) 7 J 0.5 

Zinci Valerianate. — Zinc Valerianate ... 1 0.06 



Cordiale Rubi Fructus (Blackberry Cordial). — An aromatic 
Syrup of Blackberry Juice, used as a mild astringent in bowel 
complaints. 

Succus Limonis cum Pepsino (Lime Juice and Pepsin). — Each 
fluidrachm (4 Cc.) represents 2 grains (0.12) of Pepsin. 

GLYCERITA— GLYCERITES. 

The Glycerites, or " Glyceroles," are solutions of substances in 
Glycerin. 

They are made either by direct solution, by heat, or by extrac- 
tion of a drug, as in Hydrastis ; one is made by chemical reaction 
— i. e. Boroglycerin. 

There are six official, comprising those used externally either 
alone or as additions to washes, gargles, injections, etc. : 

Percentage 
Glyceritum — by weight. 

Acidi Carbolici acid, carbolic 20. 

Acidi Tannici acid, tannic 20. 

Boroglycerini boroglyceride 50. 

Hydrastis representing hydrastis 100. 

The following are used chiefly as pharmacal agents ; the Gly- 
cerite of Starch as an excipient for Pill-masses ; and the Glycerite 
of Egg-yolk as an emulsifying agent : 
Glyceritum — 

Amyli water 10, starch 10. 

Vitelli . . . fresh egg-yolk 45. 

The Glycerite of Starch is sometimes used externally, and is 



THE LIQUID MIXTURES—INTERNAL. 85 

known as Glycerin Ointment, also as " plasma." The Glycerite of 
Egg-yolk, also known as " glyconin," has been used as an applica- 
tion to sore nipples. 

Unofficial Glycerites of the National Formulary. 
Glyceritum— 

Pepsini (Glycerole of Pepsin). — Each 4 Cc. (fluidrachm) repre- 
sents 0.3 (5 grains) of Pepsin. 
Picis Liquids (Tar). — Containing about 0.3 (5 grains) of Tar. 
Tragacanth^. — Containing about 12 per cent, of tragacanth. 

MUCILAGINES— MUCILAGES. 

The Mucilages are prepared by extracting a mucilaginous drug 
with Water or dissolving a Gum in Water. 
The following four are official : 

Gm. in 100 Cc, 
Mucilago — or percentage. 

Acaciae gum arabic 34. 

Sassafras Medullae sassafras pith 2. 

Tragacanthae glycerin 1 8 ; tragacanth 6. 

Ulmi slippery-elm bark 6. 

The Mucilages are chiefly employed as vehicles in Mixtures to 
aid in suspending insoluble substances ; as excipients in Pills and 
Troches ; and as emulsifying agents. They are sometimes used 
for their demulcent effect. 



THE LIQUID MIXTURES— INTERNAL. 
MISTUR^— MIXTURES. 

The official Mixtures are liquid preparations, for internal use, 
of medicinal substances dissolved or suspended in Water containing 
sugar, gum, or glycerin. They should be prepared extemporane- 
ously. The term Mixture is also applied to any combination of 
substances that cannot be otherwise classified. 

There are four official mixtures : 
Mistura — Gms. in 100 Cc. 

Cretae (Chalk Mixture) .... comp. chalk powder 20. 

cinnamon water 40; water, to 100. 

Ferri Comp. (Griffith's Mixt.) . . . myrrh, sugar, each 1.8 

potass, carb. 0.8 

triturate with gradual addition of rose water 70. 

ferrous sulphate, 0.6 ; spir. lavend., 6 ; rose water, to 100. 



86 A TEXT-BOOK OF MATERIA MEDICA. 

Mistura — Gms. in ioo Cc. 

Glycyrrhizae Comp pure extract glycyrrhiza 3.0 

(Brown Mixture) Spirit ether nitrous 3. 

wine antimony 6. 

tinct. opium, camph. 12. 

syrup 5 ; mucilage acacia 10; water, to 100. 

Rhei et Sodae sodium bicarbonate 3.5 

fl. exts. ipecac 0.3, rhubarb 1.5 

spirit peppermint 3.5 ; glycerin 35. ; water, to 100. 



Unofficial Mixtures of the National Formulary. 
Mistura — 

Acacia — (Mistura Gummosa, Ph. Ger.). — Acacia, pulv., Sugar, 
in Water. 

Should be freshly made when wanted for use. 

Adstringens et Escharotica (Villate's Solution). — Solu- 
tion of Lead Subacet. \\ fluidounces (45.); Sulphates of 
Copper, Zinc, each, 1 troy ounce (30.) ; Acetic Acid 1 3 fluid- 
ounces (360 Cc). 

Ammonii Chloridi (Mistura Solvens Simplex). — Ammonium 
Chloride, Purif. Ext. Glycyrrhiza, each 180 grains (12.), in 
Water 16 fluidounces (450 Cc). 

Mistura (or Mixturd) Solvens Stibiata is prepared by dis- 
solving 0.3 Antimony and Potassium Tartrate in 1000 Cc. 
of Mistura Ammonii Chloridi. 

Camphors Acida (Mistura Antidysenterica ; Hope's Mix- 
ture). — Nitric Acid 120 mins. (8 Cc); Tinct. Opium 80 
mins. (5 Cc.) ; in Camphor Water 16 fluidounces (450 Cc). 

Camphors Aromatica (Parrish's Camphor Mixture). — Tinct. 
Lavender Comp. 4 fluidounces (120 Cc.) ; Sugar 240 grains 
(15.); in Camphor Water 16 fluidounces (450 Cc). 

Carminativa (Dalby's Carminative). — Magnes. Carb. I troy 
ounce (30.); Potass. Carb. 20 grains (1.3); Tinct. Opium 
180 mins. (12 Cc) ; Oils of Caraway, Fennel, Peppermint, 
each, 4 drops (0.1); Syrup 2\ fluidounces (75 Cc.) ; in 16 
fluidounces (450 Cc). Each fluidounce (30 Cc.) represents 
about I grain of Opium (0.06). 

Chloralis et Potassii Bromidi Composita (Mixture of 
Chloral and Bromide). — Each fluidrachm (4 Cc) contains 
15 grains (1.), each, of Chloral and Potassium Bromide, 



THE LIQUID MIXTURES—INTERNAL. 87 

Mistura — 

and -§- grain (0.008), each, of Exts. Indian Cannabis and 
Hyoscyamus. 
Chloroformi et Cannabis Indict Composita {Chloroform 
Anodyne). — Each fluidrachm (4 Cc.) represents j\ minims 
(0.5 Cc), each, of Chloroform and Tinct. Indian Cannabis; 
3f minims (0.25 Cc.) Tinct. Capsicum ; and about \ grain 
(0.01) of Morphine Sulph. 
Contra Diarrhceam {Cholera Mixture). — Tinctures of Opium, 
Capsicum, Rhubarb, and Spirits of Camphor and Pepper- 
mint, each, equal volumes. 

The above formula appears to be that in most general 
use, also known under the name of " Sun Mixture." 

Of other similar preparations in more or less general use, 
the following may be mentioned here : 

2. Loomis* Diarrhea Mixture. — Tincture Opium, J fluid- 
ounce (15 Cc.) ; Tincture Rhubarb, J fluidounce (15 Cc.) ; 
Tincture Catechu Comp., 1 fluidounce (30 Cc.) ; Oil of Sas- 
safras, 20 minims (1.3 Cc.) ; Tincture Lavender Comp., to 
make 4 fluidounces (120 Cc). 

3. Squibb's Diarrhea Mixture. — Tincture Opium, 1 fluid- 
ounce (30 Cc.) ; Tincture Capsicum, 1 fluidounce (30 Cc.) ; 
Spirit of Camphor, 1 fluidounce (30 Cc.) ; Purif. Chloroform, 
180 minims (12 Cc.) ; Alcohol, enough to make 5 fluidounces 
(150 Cc). 

4. Thielemann's Mixture (Mixt. Thielemanni, Ph. Suec). — 
Wine Opium, 1 fluidounce (30 Cc.) ; Tinct. Valerian, \\ 
fluidounces (45 Cc) ; Ether, \ fluidounce (15 Cc.) ; Oil 
Peppermint, 60 minims (4 Cc.) ; Fl. Ex. Ipecac, 1 5 minims 
(1 Cc); Alcohol, to make 4 fluidounces (120 Cc). 

5. Velpeau's Diarrhea Mixture. — Tincture Opium, Tinc- 
ture Catechu Comp., Spirit Camphor, of each, equal volumes. 

Copaib^e Composita — 

1 . Lafayette Mixture. — Copaiba, 2 fluidounces (60 Cc) ; 
Tinct. Lavender Comp., 2 fluidounces (60 Cc.) ; Solution 
Potassa, \ fluidounce (15 Cc) ; Spirit Nitr. Ether, 2 fluid- 
ounces (60 Cc); Syrup, 5 fluidounces (150 Cc.) ; Mucilage 
Dextrin, to make 16 fluidounces (450 Cc). This mixture 
should be well agitated when used. Each fluidrachm con- 
tains j\ minims of Copaiba. 

2. Chapman's Mixture. — Copaiba, 4 fluidounces (125 Cc.) ; 



88 A TEXT-BOOK OF MATERIA MEDICA. 

Mistura — 

Tinct. Lav. Comp., 240 minims (15.5 Cc.) ; Tincture Opium, 
240 minims (15.5 Cc.) ; Spirit Nitro. Ether, 4 fluidounces 
(125 Cc.) ; Mucilage Acacia, 1 J fluidounces (45 Cc.) ; Water, 
to make 16 fluidounces (450 Cc). 

Expectorans, Stokes (Stokes' Expectorant). — Ammonium 
Carb., 120 grains (8.); Fl. Ext. Senega, \ fluidounce (15 
Cc); Fl. Ext. Squill, \ fluidounce (15 Cc.) ; Tinct. Opium, 
Camph., 2 J fluidounces (80 Cc.) ; Water, \\ fluidounces (45 
Cc); Syrup Tolu, to make 16 fluidounces (450 Cc). 

Guaiaci (Guaiac Mixture, Ph. Br.). — Resin Guaiac, Sugar, each, 
190 grains (12.5); Acacia Powder, 100 grains (7.); Cinna- 
mon Water, 16 fluidounces (450 Cc). To be well agitated 
when used. 

Magnesia et AsAFCETiDiE (U. S. P. 1880.). — Dewees' Carmina- 
tive. — Magnesium Carbonate, 90 grains (6.0); Tinct. Asa- 
foetida, 2 fluidrachms (8 Cc.) ; Tinct. Opium, 20 minims (1.2 
Cc); Sugar, 180 grains (12.0); Water, to make 4 fluid- 
ounces (120 Cc). 

Olei Balsamica (Balsamum Vitae Hoflrnanni, Ph. Ger.). — 
A solution of Oils of Lavender, Thyme, Lemon, Mace, 
Orange-flowers, Cloves, Cinnamon, and Balsam Peru in 
Alcohol. 

Olei Picis (Tar Mixture). — A mixture of Oil of Tar, \ fluid- 
ounce (15 Cc.) ; Chloroform, 75 minims (5 Cc) ; Oil of Pep- 
permint, 20 minims (1.3 Cc), in Elixir, to make 16 fluid- 
ounces (450 Cc). 

Rhei Composita (Squibb's Rhubarb Mixture). — Fl. Ext. 
Rhubarb, 120 minims (6. Cc.) ; Fl. Ext. Ipecac, 16 minims 
(1. Cc.) ; Sodium Bicarb., 330 grains (1 1.) ; Glycerin, 6 fluid- 
ounces (240.), in Peppermint Water, 16 fluidounces (450 Cc). 

Sassafras et Opii (Mist. Opii Alkalina ; Godfrey's Cordial). — 
A mixture of Oil of Sassafras, Tincture of Opium, and Potass. 
Carb. in Molasses, Alcohol, and Water. Each fluidrachm 
(4 Cc.) contains 2 minims (0.12) Tinct. Opium, correspond- 
ing to \ grain (0.0 1) Opium. 

Sod,e et Mentha (Soda Mint). — Sodium Bicarb., 320 grains 
(20.) ; Spirit Ammonia Arom., 4 Cc. (60 minims) ; Spear- 
mint Water, 16 fluidounces (450 Cc). 

Splenetica (Spleen Mixture; Gadberry's Mixture). — Iron 
Sulphate, Quinine Sulphate, Nitric Acid, each, 100 grains 



THE LIQUID MIXTURES-INTERNAL. 89 

Mistura — 

(7.); Potassium Nitrate, 300 grains (20.), in Water, 16 fluid- 
ounces (450 Cc). 
Sulphurica Acida (Haller's Acid Elixir, Ph. Ger.). — Sul- 
phuric Acid, 1 part ; Alcohol, to make 4 parts, by weight. 

EMULSA— EMULSIONS. 

Emulsions are liquid preparations consisting of oily ', fatty, resin- 
ous, or otherwise insoluble substances suspended in watery liquids 
by the intervention of gum, mucilage, or other viscid matter. 

For the internal administration of Oils it is often necessary to 
exhibit them in a palatable form, so that they may be borne by the 
stomach and their assimilation favored. This is usually effected by 
suspending the oil in a watery liquid or mixture by means of an 
emulsifying agent, such as acacia, etc. 

Many natural substances are intimate mixtures of oils or fats 
with water, in the form of an emulsion. Of animal products, Milk 
is a most perfect emulsion; so is Egg-yolk. From the Milk-juice 
of some plants the water evaporates and the dried milk-juice col- 
lects in the seeds, as in almonds and other nuts, or exudes from 
other portions of the plant when the parts are wounded ; in this 
way the gum-resins of asafcetida, etc. are produced. From these 
substances Emulsions may be obtained by restoring the water lost 
by evaporation — that is, by rubbing them with water in a mortar. 
In this way the so-called natural Emulsions are made. 

Artificial Emulsions. 

These are made by mixing the Oil with a certain proportion of 
the emulsifying agent, adding Water, and triturating the mixture in 
a mortar or agitating it in a flask. 

There are various methods, but these are general rules : 

The emulsification of the oil should be complete before the mixture is made up to the 
required measure. 

When alcoholic liquids are to be added, they should first be diluted as much as 
possible. 

Salts should be dissolved before being added. 

No heat should be employed, as the oil separates when an emulsion is heated. 

Emulsions should be freshly prepared and be preserved in a cold place. 

The most common emulsifying agent is Powdered Gum Acacia 
(Acacia pulv.). The Oil is thoroughly mixed by trituration in a 
mortar with one-fourth its weight of powdered Acacia. To this 
one and a half times as much water as of gum is added at once, and 
the mixture is rapidly triturated with a rotary motion of the pestle 



90 A TEXT-BOOK OF MA TERIA MEDICA. 

until it becomes stiff and assumes a milk-white color. This so- 
called " mother-emulsion " may now be diluted to the required 
measure, and other substances, flavors, etc. be added. 

Powdered Tragacanth may be used in the same way or in the 
form of mucilage, but it does not produce so permanent emulsions 
as does gum acacia. 

Mucilage of Acacia or of Irish Moss is not so satisfactory as 
powdered gum : while it produces a good emulsion, the division of 
the oil-globules is not so thorough as in the preceding : emulsifica- 
tion being incomplete, the mixture more rapidly separates into a 
heavier, watery liquid and a lighter, thick, gelatinous emulsion, 
which requires thorough mixing before use. 

Extract of malt is an excellent emulsifying agent when its use is admissible. The 
Oil should be added to' the Malt Extract contained in a capacious mortar, and incorporated 
in small quantities at a time. A good article will emulsify an equal volume of cod- 
liver oil. 

Condensed Milk and Egg-yolk produce the most perfect emulsions, and also the 
most palatable, but they rapidly ferment and spoil. 

Glycerin and sugar added to emulsions for the purpose of preservation and paya- 
bility induce separation, and their use is not advisable. 

Emulsification " by intervention " is the best and only reliable 
method to be employed with Ethereal Oils and all substances of 
themselves not emulsifiable. The process is illustrated in the 
official Chloroform Emulsion. 

Oil of Turpentine, for example, is emulsified by dissolving the Turpentine Oil in 
twice its volume of a bland fixed oil (Almond Oil), incorporating an equal weight of 
powdered Acacia, adding Water, and proceeding as with an ordinary emulsion. 

Pancreatin emulsionizes fats in preparing them for digestion, but it does not produce 
a permanent emulsion when used artificially. While, therefore, not a reliable emulsifying 
agent, it aids the assimilation of oils, and its addition to emulsions is sometimes therapeu- 
tically desirable. As it is more active in alkaline media, the Emulsion should be pre- 
pared with a little Sodium Bicarbonate. 

The addition of Alkalies to emulsions should be avoided. Soaps are not Emulsions, 
nor is the use of Soap bark to be recommended. 

Of the four official Emulsions three are natural emulsions ; one 
is artificial : 

Gm. in 100 Cc, 
Erhulsum — or percentage by vol. 

Ammoniaci ammoniac 4 

Amygdalae sweet almond 6 

sugar 3 ; acacia I 

Asafcetidae . , asafcetida, in select tears 6 

Chloroformi .... tragacanth powd. 1.5 ; chloroform 4 

expressed oil almond 6 ; water, to 100 



THE LIQUID MIXTURES— INTERNAL. 91 

Shake the Chloroform and Tragacanth together in a dry bottle, 
incorporate 25 Cc. Water, then the Almond Oil in small quantities, 
and finally in the same way add the remainder of the Water. 

Unofficial Emulsions of the National Formulary. 

Emulsions should, of all pharmaceuticals, be prepared within a 
reasonable period previous to the time of dispensing. A true 
emulsion should contain the oil simply suspended in the form of a 
mechanical mixture, which, from its very character, cannot with- 
stand the effects of variation in temperature any better than a 
natural emulsion, such as milk or emulsions of almonds, gum- 
resins, etc., and consequently quickly degenerates or spoils. 

An emulsion may be perfect — that is, the oil-globules entirely 
extinguished — yet a separation similar to that occurring in milk 
will take place, which, though in its first stage not so objection- 
able, will eventually impair the medicinal value of the preparation. 
These reasons are, it is believed, sufficient to condemn the various 
" ready-made " or patent emulsions, and to justify the physician in 
prescribing such as are kept on hand by the pharmacist, in smaller 
quantities, prepared according to these formulas. 

A typical formula for emulsions, with Acacia, is — 

fy. Olei Morrhuae 120 Cc, 3iv; 

Acaciae pulv 30 Gm., §j ; 

Aquae q. s. ad 240 Cc, iviij. 

Emulsify by trituration in a mortar, and add the flavoring. 

The following are flavors employed: (1) Gaultheria, (2) gaul- 
theria and sassafras, (3) aromatic spirit, (4) gaultheria, bitter almond, 
and coriander, (5) gaultheria, sassafras, and bitter almond, (6) gaul- 
theria and bitter almond, (7) oil of neroli, bitter almond, and cloves. 
Unless otherwise specified, that designated as No. 5 may be em- 
ployed in these Emulsions. 

The following formulas may be useful as indicating the form of 
prescription for any combination desired. Hypophosphite Salts or 
any medication desired may usually be dissolved in the water 
directed in the formula, should a preparation be indicated different 
from any of the following emulsions of the N. F. : 
Emulsio — 

Olei Morrhile cum Calcii et Sodii Phosphatibus. — Cal- 
cium Phosphate, Sodium Phosphate, of each, 1 grain in I 
fluidrachm (0.06 in 4 Cc). 



92 A TEXT-BOOK OF MA TERIA MEDICA. 

Olei Morrhile cum Calcii Lactophosphate. — Calcium 
Lactophosphate, 3 grains in 1 fluidrachm (0.2 in 4 Cc). 

Olei Morrhile cum Calcii Phosphate. — Calcium Phos- 
phate, 2 grains in 1 fluidrachm (0.12 in 4 Cc). 

Olei Morrhu^e cum Extracto Malti. — Contains 40 per 
cent. Extract of Malt. 

Olei Morrhu^e cum Hypophosphite. — The Hypophosphite 
Salt or any combination of the following : Calcium, Po- 
tassium, Sodium, or Iron, to be directed by the prescriber, 
8 grains to the fluidounce (0.5 in 30 Cc). 

Olei Morrhu^e cum Pruno Virginiana. — Wild Cherry 
(Fluid Ext.), \ fluidrachm to 1 fluidounce (2 Cc in 30 Cc). 

Olei Ricini. — 1 fluidounce (30 Cc.) contains 2\ fluidrachms 
(10 Cc.) Castor Oil, disguised by the addition of Vanilla. 

Olei Terebinthin^. — Contains 1 fluidrachm (4 Cc) Oil of 
Turpentine 1 fluidounce (in 30 Cc), prepared according to 
the following formula: 

1^. Olei Terebinthinae 3iv, 

Acaciae pulv gr. xxx, 

Vitelli Ovi (Egg-yolk) ; 
Elixir Aromatici .... ana 3iv, 
Aquae Cinnamomi . . q. s. ad ^iv, 
Make an emulsion by trituration in a mortar. 

Phosphatica (Phosphatic Emulsion). — Prepared with Glycerite 
of Egg-yolk, and contains in 1 fluidounce (30 Cc) Cod 
Liver Oil, 2 fluidrachms (8 Cc.) ; Dilute Phosphoric Acid, 
22^- minims (1.5 Cc.) ; Jamaica Rum, flavored with Bitter 
Almond and Orange Flower Water. 



12.5 


Cc; 


2.0 




15 


Cc; 


OO 


Cc. 



EXTRACTIVE PREPARATIONS. 

The active medicinal constituents, or principles, of crude drugs 
are obtained by extraction. Extraction is effected either by macera- 
tion, expression, and filtration or straining, or by maceration with 
heat, when it is called digestion, or by percolation. The liquid 
employed, termed menstruum (pi. menstrua), may be Water or Al- 
cohol, or Alcohol and Water in various proportions, sometimes 
with Glycerin. A few drugs require alkaline menstrua, some 
acid menstrua, while the oleoresins are made with Ether. 



EXTRACTIVE PREPARATIONS. 93 

The Infusions and Decoctions are the simplest preparations made 
by extraction, and represent most nearly all the soluble constitu- 
ents of the drugs. But not all drugs are adapted to this method 
of extraction nor to this exceedingly effective, though not espe- 
cially elegant, form of exhibition. 

The most generally convenient and effective class of extractive 
preparations are the Tinctures. They are the simplest form of alco- 
holic preparations, and the other more concentrated preparations 
are usually first obtained as tinctures and then concentrated by 
evaporation, so as to yield the fluid extract, extract, or resin 
respectively. 

The only accurate method for determining the doses of extrac- 
tive preparations is to compare their drug-strength. 

Thus, the doses of the respective preparations of Nux Vomica, 
based upon their relative drug-strength, would be as follows : 

Average Dose 
of Drug. of Preparation. 



Tincture . . .20%, 1 in 5, 3 grains (0.2) = 15 minims (1. Cc). 
Fluid Extract 100%, I in 1, 3 grains (0.2)= 3 minims (0.2 Cc). 
Extract . . . 1000%, 10 in 1, 3 grains (0.2)=^- grain (0.02 Gm.). 

In the same way the doses of the preparations of Opium may 
be presented : 

Average Dose 
of Drug. of Preparation. 



Tincture of Opium . 10%, 1 grain (0.06) — 10 minims (0.6 Cc). 
" " deod. 10%, I grain (0.06) = 10 minims (0.6 Cc). 

Vinegar of Opium . 10%, I grain (0.06) = 10 minims (0.6 Cc). 
Wine of Opium . . 10%, I grain (0.06) = 10 minims (0.6 Cc). 
Extract of Opium . 150%, I grain (0.06) = f grain (0.04). 

While the preparations of these two drugs are standardized 
according to their alkaloid percentage strength in the U. S. P., 
such strength is not as available for computing or estimating doses 
as is the drug-strength. The determination of alkaloidal percentage 
in preparations is a check upon their preparation, but is not of so 
much importance to the physician as it is that the preparations be 
made by a skilful and conscientious pharmacist, from the very best 
quality of material, in a thorough manner. 



94 A TEXT-BOOK OF MATERIA MEDICA. 

INFUSA— INFUSIONS. 
Unless otherwise directed, Infusions are prepared by the general 
official process : 

Of the Drug, coarsely comminuted 5 Gm. 

Boiling Water 100 Cc. 

Pour the boiling Water on the Drug in a suitable vessel, provided with a cover, and 
let it stand for half an hour ; strain, and add enough Water through the strainer to make 
100 Cc. 

Caution. — The strength of Infusions of powerful drugs — e. g. 
Ipecac — should be especially prescribed. The following Infusions 
are official, being prepared of different strengths and by other 
processes than directed in the general formula: 

Gm. in 100 Cc. 
Infusum Digitalis . alcohol, 10; cinnamon water, 15; digitalis 1.5 
Infusum Sennae Comp. (Black Draught) . . fennel 2 ; senna 6. 

manna, magnesium sulph., of each 12. 
Drugs whose active principles are volatile or changed by heat 
are prepared by percolation without heat, or cold Infusion : 

Gm. in 100 Cc. 

Infusum Cinchonae .... acid arom. sulph. 1 ; cinchona 6. 
Infusum Pruni Virginianae wild cherry 4. 

Unofficial Infusions of the National Formulary. 
Infusum — 

Bravery (U. S. P. 1880). — Brayera (Cusso), 6 ; Boiling Water, 

100 Cc. To be dispensed without straining the mixture. 
Gentians Compositum Fortius. — For preparing Infusum 

Gentianae Compositum by mixing 1 volume with 3 volumes 

of water. 
Ros,e Compositum (Compound Infusion of Rose, Ph. Br.). — 

An infusion of Red Rose in diluted Sulphuric Acid, Sugar, 

and Water. 

The Species (Teas) are mixtures of drugs contused or bruised 
for the preparation of Cataplasms ; or Infusions and Decoctions, 
sometimes designated as Haustus (Draught). The following are 
in the National Formulary : 
Species — 

Emollientes (Emollient Cataplasm, Ph. Ger.). — A mixture of 
Althaea Leaves, Mallow Leaves, Melilot Tops, Matricaria, 
and Flaxseed, equal parts of each. 



EXTRACTIVE PREPARATIONS. 95 

Species — 

Laxantes (St. Germain Tea, Ph. Ger.). — A mixture of Senna, 
Elder-flowers, Fennel, Anise, and Potassium Bitartrate. 

Pectorales (Breast Tea, Ph. Ger.). — A mixture of Althaea, 
Coltsfoot, Glycyrrhiza, Anise, Mullein Flowers, and Orris 
Root. 

Infusum Pectorale (Pectoral Infusion, or Infusion of Pec- 
toral Species) is made by infusing 1 troy ounce (30 Gm.) 
of the above in the usual manner, so as to obtain 10 fluid- 
ounces (300 Cc.) of strained product. 

DECOCTA— DECOCTIONS. 

Unless otherwise directed, Decoctions are prepared according 
to the following general process : 

Of the Drug, coarsely comminuted 5 Gm. 

Boiling water, to make 100 Cc. 

Pour the boiling Water on the Drug, contained in a suitable vessel provided with a 
cover, bring it to a boil, and let it boil for fifteen minutes; let it cool to 40 C. (104 F.), 
express, strain, and add cold Water through the strainer to make 100 Cc. 

Caution as with Infusions. 

The following Decoctions are official, as being made of strengths 
and methods other than those directed in the general process : 

Gm. in 100 Cc. 

Decoctum Cetrarise Iceland moss 5. 

Decoctum Sarsaparillae Comp. mezereum 1 ; sarsaparilla 10. 
glycyrrhiza, sassafras, guaiac wood, of each 2. 

Decoctum Aloes Compositum, N. F., is a mixture of Ext. Aloes, 
Myrrh, Saffron, Potass. Carb., Ext. Glycyrrh, Tinct. Cardamom 
Comp., and Water. — Extempore. 

aceta— vinegars. 

The Vinegars are made by extraction with Dilute Acetic Acid. 
By maceration : 

Gm. in 100 Cc. 

Acetum Opii (Black Drop) . sugar 20; nutmeg 3; opium 10. 

Scillse squill 10. 

The Vinegars of Lobelia and Sanguinaria (U. S. P. 1880) were of the same strength. 

VINA— WINES. 
The Wines are made by solution, by maceration, or by macera- 
tion and percolation. The Menstruum is White Wine, to which from 



96 A TEXT-BOOK OF MATERIA MEDICA, 

10 to 15 per cent, of Alcohol is added to aid in the extraction and 
the preservation. There are ten Wines official. 

The Natural Wines : Vinum Album and Vinum Rubrum are 
treated under Alcohol. 

Vinum — Gm. in 100 Cc. 

Antimonii . . . antimony, potass, tart. (sol. water) 0.4 

Colchici Radicis colchicum root 40. 

Colchici Seminis colchicum seed 15. 

Ergotae . ergot 15. 

Ferri Amarum . . soluble iron and quinine citrate 5. 

(Bitter Wine of Iron) tinct. orange peel 1 5 ; syrup 30. 

Ferri Citratis .... iron and ammonium citrate 4. 

syrup 10; tinct. orange peel 15. 

Ipecacuanhas alcohol 10; fl. ext. ipecac 10. 

Opii . .... . cinnamon, cloves, each, 1 ; opium 10. 

The Dose of the Vinegar and Wine of Opium is the same, 10 
minims (0.6) representing 1 grain (0.06) opii pulveris. The dose of 
the Wine of Colchicum Root is 10 minims (0.6), it being nearly 
three times the strength of the Wine of Colchicum Seed, of which 
the dose is 30 minims (2 Cc). 

Unofficial Wines of the National Formulary. 
The Wines, with a few exceptions, are prepared with White 
Wine {Vinum album, U. S.), usually with the addition of 10 per 
cent, of Alcohol, in order better to preserve the preparation. 
Vinum — 

Aloes (U. S. P. 1880). — Representing 6 per cent, of Aloes 
with Aromatics. 

Aurantii. — Sherry Wine flavored with Orange. 

Aurantii Compositum (Elixir Aurantiorum Compositum). — A 
combination of Bitter Orange Peel, Absinthium, Menyanthes, 
Cascarilla, Cinnamon, and Gentian, in Sherry Wine. Useful 
as a stomachic tonic in doses of 1 fluidrachm (4 Cc). 

Carnis (Beef and Wine). — Each fluidrachm (4 Cc.) represents 
2 grains (0.12) of Extract of Beef. 

The Extract of Beef in this and similar preparations is that which is pre- 
pared by Liebig's method. 

Carnis et Ferri (Beef, Wine, and Iron). — Each fluidrachm 
(4 Cc.) represents 2 grains (0.12) of Extract of Beef and 
2 minims (0.12) Tincture of Citro-chloride ("Tasteless" 
Tincture) of Iron. 






EXTRACTIVE PREPARATIONS. 97 

Vinum — 

Carnis, Ferri et Cinchona (Beef, Wine, Iron, and Cinchona). 

— Each fluidrachm (4 Cc.) represents 2 grains (0.12) Extract 

of Beef, 2 minims (0.2) Tincture Citro-chloride of Iron, and 

small quantities of Cinchona alkaloids, in Angelica Wine. 
Cocs (Erythroxyli). — Each fluidounce (30 Cc.) represents 

30 grains (2 Gm.) of Coca in Claret Wine. 
Cocs Aromaticum. — Each fluidounce (30 Cc.) represents 30 

grains (2 Gm.) of Coca with Aromatics. 
Fraxini Americans (White Ash). — Each fluidrachm (4 Cc.) 

represents 30 grains (2 Gm.) of Fraxinus (bark). 
Pepsini (Pepsin). — Each fluidrachm (4 Cc.) represents 1 grain 

(0.06) of Pepsin. 
Picis (Tar). — A saturated solution of Tar, in Sherry Wine. 
Pruni Virginians (Wild Cherry). — Each fluidrachm (4 Cc.) 

represents 15 grains (1 Gm.) of Wild Cherry, in Angelica 

Wine. 
Pruni Virginians Ferratum (Wild Cherry, Ferrated). — Each 

fluidrachm (4 Cc.) represents 5 minims (0.3 Cc.) of Tincture 

of Citro-chloride of Iron and 13J grains (0.9 Gm.) of Wild 

Cherry, in Angelica Wine. 
Rhei (U. S. P. 1880). — Representing 10 per cent, of Rhubarb 

and 1 per cent, of Calamus. 

TINCTURE— TINCTURES. 

Tinctures are liquid preparations made by the extraction of 
Drugs with menstrua of Alcohol and Water in various propor- 
tions. They are prepared by maceration and filtration ; also by 
percolation : 

By maceration and filtration, those containing resins and oleo- 
resins, Musk, and tinctures of fresh herbs ; in a few instances with 
heat, the Tincture of Quillaja and Tincture of Strophanthus. 

By percolation, when prepared from dried vegetable drugs — i. e. 
barks, leaves, roots, etc., usually after brief maceration. 

By solution, mixing a solution (chloride of iron) or dissolving 
a solid in Alcohol (Iodine, Ext. Nux Vomica). 

Assayed Tinctures. — Two of the most important Tinctures are 
required to be of certain specified alkaloidal strengths, and their 
classification according to their respective drug-strengths is there- 
fore only approximately correct. 

Tinctura Opii is made so as to represent from 1.3 to 1.5 per 
7 



98 



A TEXT-BOOK OF MA TERIA MEDICA. 



cent, of crystallized morphine, the proportion obtained from 10 per 
cent, of Opii Pulvis, U. S. 

Tinctura Nucis Vomica is made by solution of 2 per cent, of the 
official Extract, representing about ten times its weight of the drug ; 
the Tincture therefore represents 20 per cent, of the drug, and con- 
tains 0.3 per cent, total alkaloids. 

Tincturse Herbarum Recentium, — Tinctures of Fresh Herbs, 
or " Green Tinctures," similar to the Homoeopathic or so-called 
" German Tinctures," also to the specific tinctures of the Eclectics, 
when not otherwise directed are to be prepared by the following 
general formula: 

Take of the fresh herb, bruised or crushed, 50 Gm. ; macerate for fourteen days in 
Alcohol 100 Cc. ; express the liquid and filter. 



Tinctures of the U. S. P. 



Name. 



Tinctura — 

Aconiti 

Aloes 



Aloes et Myrrhae 

Arnicae Florum 
Arnicae Radicis 
Asafcetidae . . , 
Aurantii Amarae , 
Aurantii Dulcis 
Belladonnae Foliorum 
Benzoini 



Benzoini Composita 
(Turlington's Bal- 
sam). 



Bryoniae .... 
Calendulas . . . 
Calumbae .... 
Cannabis Indicae . 
Cantharidis . . . 
Capsici . . . . , 
Cardamomi . . . 



Cardamomi "I 
Composita > 



Gm. 
Drug. in 

100 Cc 

• Root 35 

f Aloes .... 10 

I Licorice .... 10 

{Aloes 10 

Myrrh 10 

Licorice 10 . 

. Flowers 20 

. Root 10 

. Gum resin ... 20 

. Bitter Orange peel 20 

. Sweet 20 

. Leaves ..... 15 

. Balsam ..... 20 

f Benzoin .... 12" 

I Storax 8 

] Tolu ; 4 

I Aloes 2 . 

. Root 10 

. Florets 20 

. Root .••... 10 

. Flower tops ... 15 

. Insect 5 

5 

10 
2 

2 

1 



Menstrua. 
Alcohol, Drug, 
per cent. Grains. Gm. 

O.06 



Average Dose. 



Fruit .... 
Fruit .... 
Cardamom . . 
Cassia Cinnam. 
Caraway . . 
Cochineal .... 0.5 
Glycerin 5 



70 
75 



100 

100 

60 

100 

100 

95 

5o 



50 



3 
6 
6 

5 

1 

6 



Rep. 
Cc. 

0.2 



0.4 



O.8 



Tinct. 
Min. 

3 
60 



60 



50 


3 


0.2 


1. 


15 


65 


3 


0.2 


2. 


30 


IOO 


6 


0.4 


2. 


30 


60 


6 


0.4 


2. 


30 


IOO 


6 


0.4 


2. 


30 


50 


1* 


O.I 


0.6 


10 


IOO 


6 


0.4 


2. 


30 



8 0.5 



0.2 

0.4 

0.4 

°-3 
0.015 
0.1 
0.4 



30 



30 
30 
60 

30 
5 

30 
60 



60 



EXTRACTIVE PREPARATIONS. 



99 



Name. 



Drug. 



Tinctura — 

Catechu Composita 



Cinchona? Composita 
(Huxham's Tine- - 
ture.) 



Catechu 
Cinnamon 

Chiratse Herb . . 

Cimicifugae Rhizome 

Cinchonae Bark . . . 

" Red Cinchona 
Bitter Orange 
Serpentaria 
Glycerin 

Cinnamomi Ceylon 

Colchici Seminis . . . Seed . 

Croci Saffron . 

Cubebae Fruit . 

Digitalis Leaves . 

Ferri Chloridi .... Solution 

Gallae Nutgall 

Gelsemii Root . 

{Gentian 
Bitter Orange 
Cardamom 

Guaiaci Resin . 

Guaiaci Ammoniata . . Resin . 

Humuli Hops . 

Hydrastis Rhizome 

Hyoscyami Herb . 

Iodi ........ Iodine . 

t Ipecac . 
Ipecacuanhas et Opii { pi U m deod 

Kino Insp. juice 

Krameriae Rhatany . 

Lactucarii Insp. juice 

rOil Lavender 

Oil Rosemary 

Cinnamon . 

Cloves . . . 

Nutmeg . . 
L Red Saunders 

Lobelias Herb . . . 

Matico Leaves . . . 

Moschi Musk . . . 

Myrrhae Gum resin . 

Nucis Vomicae .... Extract . . 

Opii Pulv. Opium 

r Opium pulv. 



Lavandulae Composita 
(For flavoring.) 



Opii Camphorata 
(Paregoric.) 

L.ofC. 



| Acid Benzoic 
"{ Camphor . . 

Oil Anise 
I Glycerin . . 



Gm. Menstrua, 
in Alcohol, Drug. 

100 Cc. per cent. Grains. Gut. 

10 \ 50 12 0.8 
10 J 



Average Dose. 



Rep. Tinct. 
Cc. Min. 



IO 
20 
20 



peel 8 I 

-J 

7-5 J 
10 

15 
10 
20 

15 

25 Cc. 
20 



*5 

IO 

4 
1 

20 
20 
20 
20 
15 
7 

10 
10 

IO 

20 

50 
0.8 

0.2 

2. 
0.5 



20 
IO 

5 

20 
2 

10 
0.4 
0.4 
0.4 
0.4 
4- 



65 

100 

67 

85 



75 
60 

50 
100 

50 

75 
90 

65 
60 



5o 

50 

50 
100 

20 

65 
50 
50 



75 



50 
50 

5o 
100 

75 
50 



12 

12 

6 

12 

12 
5 



0.4 
0.8 
0.8 

0.8 



0.4 

°-3 

0.4 
0.8 

0.15 
0.25 
0.8 
0.15 

0.8 

0.8 
0.4 
0.8 
0.8 
0.3 



Only externally 
0.06 



1 

6 0.4 
•'2 0.8 
For syrup. 



0.4 

0.2 

0.1 

0.4 

0.02 

0.06 



2. 

2. 
2. 
2. 

0.6 



Opium 
50 \ 0.015 4- 



60 

60 
60 
60 

60 

60 

30 

60 
60 
15 
15 
60 

15 
60 

60 

3o 
60 
60 
30 

10 

60 
60 



30 



30 
30 
30 
30 
15 
10 



60 



IOO 



A TEXT-BOOK OF MATERIA MEDIC A, 



Name. Drug. 

Tinctura — 

Opii Deodorata . . . Opium . . . 
Physostigmatis .... Calabar Bean 

Pyrethri Pellitory . 

Quassias Wood . . 

Quillajae Soap Bark 

f Rhubarb . 

\ Cardamom 

rRhubarb . 
Cinnamon 

\ Cloves . . 



Rhei 



Rhei Aromatica 
(For syrup.) 



Nutmeg 



Rhei Dulcis (Sweet \ 
Tincture of Rhu- f 
barb.) J 



Gm. 


Menstrua 

Alcohol, 

. per cent. 




Average Dose. 


in 
ioo Cc 


Drug. 
Grains. Gm. 


Rep. 
Cc. 


Tinct. 
Min. 


IO 


20 


I 


O.06 


O.6 


IO 


15 


IOO 


I 


O.06 


O.4 


7 


20 


IOO 


Externally. 






IO 


35 


3 


0.2 


2. 


30 


20 


35 


6 


O.4 


2. 


30 


»} 60 


8 


0.5 


4- 


60 


20 

4 
4 


50 


15 


I. 


4- 


60 


2 












10. 












10" 












4 
4 


5o 




• • 


5. 


120 


io^ 












15 


60 


5 


0.3 


2. 


30 


15 

IO 


75 
65 


6 


O.I5 
O.4 


I. 
4- 


15 
60 


15 


50 


4 


O.I5 


I. 


15 


5 


65 


i 


O.OI5 


0.3 


5 


10 


65 


3 


0.2 


2. 


30 


IO 


IOO 


3 


0.2 


2. 


30 


20 


75 


12 


O.8 


4. 


60 


20 




6 


O.4 


2. 


30 


IO 


65 


3 


0.2 


2. 


30 


40 


IOO 


2 


C.I 2 


0.3 


5 


20 


IOO 


6 


O.4 


2. 


30 



Glycerin . 
f Rhubarb . 

Glycyrrhiza 

Anise . . 

Cardamom 
L Glycerin . 

Sanguinariae Blood-root 

Scillae Squill . , 

Serpentariae Rhizome . 

Stramonii Seminis . . Seed . . 

Strophanthi Seed . . 

Sumbul Musk-root 

Tolutana Tolu . . 

Valerianae Root . . 

Valerianae Ammoniatae. Root . . 

Vanillse Fruit . . 

Veratri Viridi .... Rhizome . 
Zingiberis Ginger . . 

Unofficial Tinctures of the National Formulary. 
Tinctura — 

Amara (Bitter Tincture, Ph. Ger.). — Containing Gentian, Cen- 
taury, Bitter Orange Peel, Orange Berries, and Zedoary. 

Antacrida (Dysmenorrhcea Mixture ; Fenner's Guaiac Mix- 
ture). — A mixture of Guaiac, Canada Turpentine, Oil of Sas- 
safras, and \ grain (0.02) Corrosive Mercuric Chloride in each 
fluidrachm (4 Cc). Dose, from 10 to 20 minims (0.6 to 
1.3 Cc). 

Antiperiodica (Warburg's Tincture). — With Aloes: Rhubarb, 
Angelica Seed, of each, grains 56 (4.) ; Elecampane, Saf- 
fron, Fennel, of each, grains 28 (2.) ; Aloes (aq. ext), Gen- 
tian, Zedoary, Cubeb, Myrrh, White Agaric, Camphor, of 
each, grains 14 (1.); Quinine Sulphate, grains 160 (10.); 
Diluted Alcohol, enough to make fluidounces 16 (473 Cc). 



EXTRACTIVE PREPARATIONS. IOI 

Tinctura — 

Antiperiodica (Warburg's). — The preceding without Aloes. 
Each fiuidounce (30 Cc.) of either tincture contains 10 
grains (0.6) of Quinine Sulphate. 

Aromatica (Stomachic, Ph. Ger.). — A combination of Cinna- 
mon, Ginger, Galangal, Cloves, and Cardamom. 

Capsici et Myrrh^e (Hot Drops). — The preparation popularly 
known as " Number Six." 

Cinchona DETANNATiE. — For admixture with preparations 
containing Iron. 

Conii (U. S. P. 1880). — Representing 15 per cent, of Conium. 

Coto. — This preparation contains 7 \ grains (0.5) true Bolivian 
Bark in each fluidrachm (4 Cc). The Para Coto, frequently 
employed, differs considerably from the above. 

Ferri Chloridi ^Etherea (Bestucheff's Tincture ; Lamott's 
Drops, Ph. Ger.). — Each fluidrachm (4 Cc.) represents about 
\ grain (0.3) Metallic Iron. 

Ferri Citro-chloridi (Tasteless Tincture of Iron). — Practi- 
cally identical in the strength of Iron, but not in Alcohol, 
with the official Tincture of Chloride of Iron, containing an 
amount of Iron equivalent to y\ grains (0.5) of Dry Chloride 
of Iron in each fluidrachm (4 Cc). 

A convenient form of Iron for admixture with Tinctures 
of vegetable astringent drugs, such as Gentian and Cinchona, 
preparations of which it does not, unlike other iron com- 
pounds, discolor. 

Ferri Pomata (Ferrated Extract of Apples ; Malate of Iron, 
Ph. Ger.). — Each fluidrachm (4 Cc.) represents about f 
grain (0.025) of Metallic Iron. 

Guaiaci Composita (Dewees' Tincture of Guaiac). — Each 
fluidrachm (4 Cc.) represents 7 J grains (0.5) Guaiac. 

iGNATiiE (U. S. P. 1880). — Representing 10 per cent, of 
Ignatia. 

Iodi (Churchill's). — A solution of 10 grains (0.6) Iodine in 
each fluidrachm (4 Cc), with Potassium Iodide in Alcohol. 
Not to be confounded with Churchill's Iodine Caustic 
(Liquor Iodi Causticus). 

Iodi Decolorata (Colorless Tincture of Iodine). — Contain- 
ing about 1 per cent, of Ammonium Iodide, with some 
other Iodine compounds, in alcoholic solution ; for external 
use. 



102 A TEXT-BOOK OF MATERIA MEDICA. 

Tinctura — 

Jalaps (U. S. P. 1870). — Each fluidrachm (4 Cc.) represents 
about 10 grains (0.6) Jalap. 

Jalap^e Composita. — Each fluidrachm (4 Cc.) represents y\ 
grains (0.5) Jalap and about 2 grains (0.12) Scammony. 

Kino Composita — 

Tinctures of Kino, Opium, each . . minims 180 12. Cc. 

Spirit of Camphor " 130 8.5 

Oil of Cloves " 2J 0.15 

Aromatic Spirit of Ammonia . . " 15 1. 

Cochineal grains 16 1. 

Diluted Alcohol to make fluidounces 4 . . . . 120. 

Each fluidrachm (4 Cc.) represents \ grain (0.03), each, 
of Kino and Opium. 

Papaveris (Poppy). — Each fluidrachm (4 Cc.) represents 30 
grains (2.) of Poppy (Capsule). 

Pectoralis (Bateman's Pectoral Drops). — A popular mixture 
of Opium, Catechu, Camphor, and Oil of Anise, containing 
2\ minims (0.15) Tincture of Opium (J- grain Pulv. Opium) 
in each fluidrachm (4 Cc). 

Persionis (Cudbear). — Intended as a coloring agent when a 
bright-red tint or color is to be produced, particularly in 
acid liquids. 

Persionis Composita. — A mixture of Cudbear and Caramel, 
intended as a coloring agent when a brownish-red tint or 
color is to be reproduced. 

Pimpinella (Pimpinella, Ph. Ger.). — Each fluidrachm (4 Cc) # 
represents about 10 grains (0.6) Pimpinella Root. 

Rhei Aquosa (Rhubarb, Aqueous, Ph. Ger.). — Each fluid- 
drachm (4 Cc.) represents about 5f grains (0.4) of Rhu- 
barb, with alkalies, flavored with Cinnamon. 

Rhei et Gentians. — Each fluidrachm (4 Cc.) represents 5 
grains (0.3) of Rhubarb arid 1 grain (0.06) of Gentian. 

Rhei Vinosa (Rhubarb, Vinous, Ph. Ger.). — Each fluidrachm 
(4 Cc.) represents about 5 grains (0.3) Rhubarb, with Bitter 
Orange and Cardamom, in Sweet Sherry Wine. 

Saponis Viridis Composita. — A solution of about 15 per 
cent, of Green Soap and 2 per cent, of Oil of Cade. 

Tincture vEthere/e (Ethereal Tinctures). — The drug, prop- 
erly comminuted, troy ounces 2 (60 Gm.) ; Stronger Ether, 
1 volume ; Alcohol, 2 volumes ; enough to make fluid- 



EXTRACTIVE PREPARATIONS. 103 

Tinctura — 

ounces 16 (473 Cc). A general formula for the prepara- 
tion of Ethereal Tinctures of Belladonna, Castor, Digitalis. 
Lobelia, Valerian, and other drugs. Official in several 
European pharmacopoeias, and sometimes prescribed by 
foreign physicians. 

Tolutana Solubilis (Tolu, Soluble). — A so-called soluble 
essence of Tolu, for flavoring. 

Vanillini Composita. — A solution of Vanillin and Coumarin, 
intended for flavoring. 

Zedoarle Amara (Zedoary Comp.). — Similar to, but not 
identical with, the Tinctura Carminativa, Wedelii, etc., for- 
merly official in some Continental pharmacopoeias. 

Each fluidrachm (4 Cc.) represents 15 grains (1 Gm.) of 
Zedoary; *j\ grains (0.5) of Aloes, and 3f grains (0.25), each, 
of Rhubarb, Gentian, White Agaric, and Saffron. 

extracta fluida— fluid extracts. 

Fluid Extracts may be defined as a class of concentrated 
tinctures of such strength as to represent the drug, volume for 
weight. 

The fluid extracts of the U. S. P. previous to 1880 represented 
I grain of drug in 1 minim, or 1 troy ounce in 1 fluidounce. In 
the U. S. P. of 1880 the standard adopted was 1 Gm. in 1 Cc, and 
this strength has been retained as the standard of the U. S. P. 1 890. 

Fluid extracts are made by percolation, maceration, or digestion. 
Except on a large scale or by fractional percolation, they cannot 
be prepared by simple percolation without evaporation to concen- 
trate the percolate to the required measure. 

Fractional percolation or repercolation, or simultaneous frac- 
tional percolation, by employment of which the use of heat for 
concentrating the percolate is avoided, may be used to advantage 
when the quantity operated upon is sufficiently large to warrant 
the greater time and attention required. 

The following is the process chiefly employed : 

In proceeding to percolate 100 Gm. of the drug, according to 
directions, the first 80 to 90 Cc. are reserved, and percolation con- 
tinued until the exhaustion is completed. The weak percolate is 
evaporated to a soft extract (the alcohol being recovered) and dis- 
solved in the reserved percolate. Sufficient menstruum is then 
added to make the product measure 100 Cc. 



104 A TEXT-BOOK OF MATERIA MEDICA. 

Average Dose. 



Official Name of Drug. Part. Cc. Minims. 

Extractum Fluidum — 

Aconiti Aconitum Napellus . . Tuber . . . 0.06 1 

Apocyni Apocynum Cannabinum Root . . . . 1. 15 

Arnicas Radicis . . Arnica montana . . Root .... 0.5 8 

Aromaticum .... Pulvis Aromaticus . 0.5 8 

Asclepiadis .... Asclepias tuberosa Root .... 2. 30 

Aspidospermatis . . Aspidosperma Quebracho-bianco . Bark ... 2. 30 

Aurantii Amari . . Citrus vulgaris Rind. . . . 1. 15 

Belladonnas Radicis . Atropa Belladonna Root. . . . 0.2 3 

Buchu Barosma betulina Leaves ... 2. 30 

Calami Acorus Calamus Rhizome . . 2. 30 

Calumbse Jateorrhiza palmata Root .... 2. 30 

Cannabis Indicas . . Cannabis sativa Fl. Tops . . 0.6 10 

Capsici Capsicum fastigiatum Fruit .... 0.2 3 

Castanege Castanea dentata . . , Leaves . . .4. 60 

Chimaphilge .... Chimaphila umbellata Leaves ... 2. 30 

Chiratae Swertia Chirata Plant .... 2. 30 

Cimicifugae .... Cimicifuga racemosa Rhizome . . 2. 30 

Cinchonas Cinchona Calisaya Bark .... 2. 30 

Cocas Erythroxylon Coca Leaves ... 2. 30 

Colchici Radicis . . Colchicum autumnale Corm . . . 0.3 5 

Colchici Seminis . . Colchicum autumnale ...... Seed .... 0.3 5 

Conii Conium maculatum Fruit .... 0.25 4 

Convallarias .... Convallaria majalis Rhizome . . 0.6 10 

Cubebas Piper Cubeba Fruit .... 2. 30 

Cusso Hagenia Abyssinica Inflor. ... 4. 60 

Cypripedii .... Cypripedium pubescens Rhizome . . I. 15 

Digitalis Digitalis purpurea Leaves ... 0.12 2 

Dulcamaras .... Solanum Dulcamara Branches . . 2. 30 

Ergotae Claviceps purpurea Sclerotium .2. 30 

Eriodictyi Eriodictyon glutinosum Leaves ... 2. 30 

Eucalypti Eucalyptus globulus Leaves . . . 1. 15 

Eupatorii Eupatorium perfoliatum Herb .... 2. 30 

Frangulas Rhamnus Frangula Bark .... 4. 60 

Gelsemii Gelsemium sempervirens .... Rhizome . . 0.2 3 

Gentianas Gentiana lutea Root .... 1. 3 20 

Geranii Geranium maculatum Rhizome . . 2. 30 

Glycyrrhizas .... Glycyrrhiza glabra - . Root .... 4. 60 

Gossypii Radicis . . Gossypium herbaceum Root Bark . 2. 30 

Grindeliae Grindelia robusta Leaves ... 2. 30 

Guaranae . . , . . Paullinia Cupana Seeds ... 4. 60 

Hamamelidis , . . Hamamelis Virginiana Leaves ... 2. 30 

Hydrastis Hydrastis Canadensis Rhizome . . 2. 30 

Hyoscyami .... Hyoscyamus niger Herb ... 0.3 5 

Ipecacuanhas . . . Cephaelis Ipecacuanha Root .... 0.06-2. I -30 

Iridis Iris versicolor Rhizome . . I. 15 

Krameriae Krameria triandra Root .... 2. 30 

Lappas Arctium Lappa Root .... 2. 30 

Leptandrae .... Veronica Virginica Rhizome . . 2. 30 



EXTRACTIVE PREPARATIONS. 



™5 



Average Dose. 



Official Name 
Extractum Fluidum 

Lobeliae 

Lupulinae 

Matico 

Menispermi . . . . 

Mezerii 

Nucis Vomicae . . . 

Pareirae 

Phytolacca Radicis . 

Pilocarpi 

Podophylli .... 
Pruni Virginianae . 

Quassia 

Rhamni Purshianae . 

Rhei 

Rhois Glabrae . . . 

Rosae 

Rubi ....... 

Rumicis 

Sabinae 

Sanguinariae .... 
Sarsaparillae .... 

Sarsaparillae Com 

positum - 

Scillae .... 

Scoparii 

Scutellariae .... 

Senegas 

Sennae 

Serpentariae .... 

Spigeliae 

Stillingiae 

Stramonii Seminis . 

Taraxaci 

Tritici 

Uvae Ursi 

. Valerianae 

Veratri Viridis . . . 
Viburni Opuli . . . 
Viburni Prunifolii . 
Xanthoxyli .... 
Zingiberis 



Drug. 



Part. 



Cc. 

O.6 
O.6 

4- 
2. 



Lobelia inflata .... ..... Herb . . 

Humulus Lupulus Powder . 

Piper angustifolium Leaves . 

Menispermum Canadense .... Rhizome 

Daphne Mezereum Bark .... 0.3 

Strychnos Nux-vomica Seed .... 0.2 

Chondodendrum tomentosum . . . Root .... 2. 

Phytolacca decandra Root . . . .0.5 

Pilocarpus Selloanus (Jaborandi) . Leaves ... 2. 

Podophyllum peltatum Rhizome . . 0.6 

Prunus serolina Bark .... 2. 

Picraena excelsa Wood . . . 0.5 

(Cascara sagrada) Bark . . . .2. 

Rheum officinale Root . . . .1. 

Rhus glabra Leaves ... 2. 

Rosa Gallica Petals ... 2. 

Rubus villosus Root Bark . 2. 

Rumex crispus Root .... 4. 

Juniperus Sabina Tops .... 0.5 

Sanguinaria Canadensis Rhizome . . 0.3 

Smilax officinalis, etc Root .... 4. 

Sarsaparilla, 75 ~) 
Glycyrrhiza, 12 

Sassafras, 10 f 

Mezereum, 3 1 

Urginea maritima Bulb .... 0.3 

Cytisus Scoparius Tops . . . .1. 

Scutellaria lateriflora Herb ... 2. 

Polygala Senega Root . . . .0.3 

Cassia acutifolia and Angust. . . Leaves ... 4. 

Aristolochia Serpentaria Rhizome . .1. 

Spigelia Marilandica Rhizome . . 2. 

Stillingia sylvatica Root .... 2. 

Datura Stramonium Seed . . . .0.2 

Taraxacum officinale Root .... 4. 

Agropyrum repens Rhizome . . 4. 

Arctostaphylos Uva Ursi .... Leaves ... 2. 

Valeriana officinalis Rhizome . . 2. 

Veratrum viride Rhizome . .0.12 

(Cramp bark) Bark .... 2. 

(Black haw) Bark .... 2. 

Xanthoxylum Americanum . . . Bark . . . .1. 
Zingiber officinale Rhizome . . 0.6 



Minims. 

IO 
IO 
60 
30 

5 

3 

30 

8 

30 
10 

30 

8 

30 
15 
30 
30 
30 
60 
8 

5 
60 



30 

5 

15 
30 

5 
60 

15 
30 
30 

3 
60 
60 
30 
30 

2 

30 
30 
15 
10 



Unofficial Fluid Extracts of the National Formulary. 

Unless otherwise indicated, the dose of the following Fluid Ex- 
tracts is from \ to I fluidrachm (2 to 4 Cc.) : 



106 A TEXT-BOOK OF MATERIA MEDICA. 

Extractum Fluidum — 

Adonidis. — Root of Adonis vernalis L. (Bird's Eye). 
Aletridis. — Rhizome of Aletris farinosa L. (Stargrass). 
Angelica Radicis. — Root of Archangelica L. (Angelica). 
Apii Graveolentis. — Seed of Apium graveolens L. (Celery). 
Arali^e Racemose. — Root of Aralia racemosa L. (American 

Spikenard). 
Arnica Florum. — Flower heads of Arnica montana L. (Ar- 
nica). 
Berberidis Vulgaris. — Bark of the root of Berberis vulgaris 

L. (Barberry). 
Boldi. — Leaves of Peumus Boldus Molina (Boldo). 
Buchu Compositum. — A combination of Buchu, 10; Cubeb, 

2 ; Juniper, 2 ; Uva Ursi, 2 parts. 
Calendula. — Flowering, herb of Calendula officinalis L. 

(Marigold). 
Camellia. — Leaves of Camellia Thea Link (Tea). The best 

quality of commercial black tea, " Formosa Oolong," to be 

employed for this preparation. 
Caulophylli. — Rhizome and rootlets of Caulophyllum thalic- 

troides Mich. (Blue Cohosh). 
Coffee Viridis. — Unroasted seeds of Coffea Arabica L. 
Coffe^e Tost,e. — Roasted seeds of Coffea Arabica L. 

The N. F. recommends equal portions of Java and Mocha 

to be employed in preparing the Fluid Extracts of Coffee. 
CoNVALLARiiE Florum. — Flowers of Convallaria majalis L. 

(Lily of the Valley). 
Coptis. — Rhizome of Coptis trifolia Salisb. (Goldthread). 
Cornus Circinat^:. — Bark of Cornus circinata L'Her. (Green 

Osier.) 
Cornus Florida (U. S. P. 1880). — Dogwood Bark. 
Corydalis. — Tubers of Dicentra Canadensis De C. (Turkey 

Corn). 
Coto. — Coto bark, undetermined tree. Dose, from 5 to 15 

minims (0.3 to 1 Cc). 
Fuci. — Thallus of Fucus vesiculosus L. (Bladder-wrack). 
Helianthemi. — Herb of Helianthemum Canadense Mich. 

(Frost-wort). 
Humuli. — Strobiles of Humulus Lupulus L. (Hops). 
Hydrangea. — Root of Hydrangea arborescens L. (Seven 

Barks). 



EXTRACTIVE PREPARATIONS. loy 

Extractum Fluidum — 

Jalaps. — Tuber of Exogonium purga Benth. (Jalap). Dose, 
from 15 to 20 minims (1 to 1.3 Cc). 

Juglandis. — Bark of the root of Juglans cinerea L. (Butternut). 

Juniperi. — Fruit of Juniperus communis L. 

Kava. — Root of Piper methysticum Forster (Kava; Kava- 
Kava). 

Lactucarii (U. S. P. 1880). — Insp. juice of Lactuca virosa L. 

Maltl— (Fluid Extract of Malt). 

Menyanthis. — Leaves of Menyanthes trifoliata L. (Buckbean ; 
Trifolium fibrinum, Ph. G.). 

Mezerei (U. S. P. 1880).— Bark of Daphne Mezereum L. 
Dose, from 5 to 10 minims (0.3-0.6 Cc). 

Petroselini Radicis. — Root of Petroselinum sativum Hoff- 
man (Parsley). 

QuillaJjE. — Bark of Quillaja Saponaria Molina (Soap Bark). 

Rhamni Purshian^e Aromaticum. — Cascara Sagrada de- 
prived of its bitter taste. 

Rhei Aromaticum. — A combination of Rhubarb, Cinnamon, 
Cloves, and Nutmeg. 

Senn,e Deodoratum (Aqueous Fluid Extract of Senna). — 
This preparation is free from the objectionable " griping " 
qualities of the ordinary fluid extract. 

Sterculi^e. — Seeds of Sterculia acuminata R. Brown (Cola 
or Kola). 

StilllingIjE Compositum (Stiljingia Comp.). — Stillingia, Cory- 
dalis, each, 4 parts ; Iris, Sambucus, Chimaphila, each, 2 
parts ; Coriander, Xanthoxylum Berries, each, 1 part. 
Trillii. — Rhizome of Trillium erectum L. (Bethroot). 

Turners. — Leaves of Turnera microphylla De C. (Damiana). 

Urtic^e. — Root of Urtica dioica L. (Nettle). 

Verbasci. — Leaves (and flowers) of Verbascum Thapsus L. 

Verbena. — Root of Verbena hastata L. (Vervain). 

Ze,e. — Stigmatum Maydis ; Corn Silk ; Stigmata of Zea Mays 
L. (Indian Corn). 
As a rule, a Fluid Extract is made of every vegetable drug 
which is a part of a plant. There are altogether about 500 Fluid 
Extracts. Relatively, the Fluid Extracts are not as strong as the 
Tinctures, but they have the great advantage over the latter in that 
they are more concentrated and of uniform drug-strength — the 
strength of the drug. 



108 A TEXT-BOOK OF MA TERIA MEDICA. 

EXTRACTA— EXTRACTS. 
Extracts — or " solid " extracts as they are termed, to distinguish 
them from fluid extracts — are the soluble active principles of vege- 
table drugs, concentrated by evaporation to a soft solid or a plastic 
mass of pilular consistence. 

The strength of an extract depends upon the amount of the 
crude drug it represents. Hence, the smaller the percentage of 
extract obtained from a drug, the greater the relative strength 
of the extract, provided that the drug be exhausted with menstrua 
adapted to secure all the active principles in this form. 

The yield of extract is influenced by the character of the men- 
struum employed : with a few drugs like Rhubarb the quality of the 
drug sometimes governs the yield, the least percentage being 
obtained from the poorest quality. 

As a general rule, the more aqueous the menstrua, the greater 
the yield of extract ; conversely, the more alcoholic the menstrua, 
the smaller the yield of extract. To obtain the extracts, therefore, 
of official strength it is necessary to use official menstrua in the 
extraction. 

Thus the extracts of different drugs are as many times stronger 
than the drug as the quotient obtained by dividing the drug at 
ioo by the percentage yield. For example : Podophyllum yields 
10 per cent, of extract ; then 100^-10=10; that is, the extract is 
ten times as strong as the drug and the fluid extract, or 0.1 of the 
extract represents 1 Gm. of the drug or 1 Cc. of the fluid extract. 
The drug-strengths of the official Extracts, calculated by this 
method, as well as their relative doses based upon the amounts of 
drug they represent, are exhibited in the table given on page 109. 

The 33 official Extracts are made by extraction with alcoholic 
menstrua or with water, sometimes by the addition of acid or 
alkali. 

There are four extracts made by the addition of powders to 
the extracts, including the Extract of Colocynth, the Compound 
Extract of Colocynth, and the assayed extracts, made by the addi- 
tion of Sugar of Milk to represent a certain alkaloidal strength in 
the powdered extract. 

Extractum Nucis Vomicae contains 15 per cent, of total alka- 
loids ; 1 Gm. represents about 10 Gm. of drug. 

Extractum Opii contains 18 per cent, of crystallized morphine; 
I Gm. represents 2 Gm. of normal moist opium, about 1.4 Opii 
pulvis (14 per cent, morphine). 



EXTRACTIVE PREPARATIONS. 



ioq 



Table showing the Drug-strength and the Average Doses of the 

Official Extracts. 



Extractum. 



Part. 



Aconiti .... 
Aloes (aqueous) 
Arnicae .... 
Belladonnse Fol. Alcoholic. 
Cannabis Indicae .... 

Cimicifugae 

Cinchonas (Calisaya) 
Colchici (acetic) .... 
Colocynthidis (powder) . 
Ext. 
Colocynthidis Com- 
positum (powder) 



Root 



Conii (acetic) . . , 

Digitalis 

Ergotae ....... 

Euonymi 

Gentianae (aqueous) 
Glycyrrhizae (stick) , 
Glycyrrhizae Purum (ammon 
Haematoxyli (aqueous) 

Hyoscyami 

Iridis 

Jalapae 

Juglandis 

Krameriae (aqueous) . 
Leptandrae . ... 
Nucis Vomicae (powder) 
Opii (powder) ..... 
Physostigmatis .... 

Podophylli 

Quassiae (aqueous) . . 

Rhei 

Stramonii 

Taraxaci (aqueous) . . 
Uvae Ursi 



. Root . 

. Leaves 

. Herb . 

. Rhizome 

. Bark 

. Corm 

. Fruit 
Colocynth, 16; 
Cardamom, 6 ; Aloes, 
50; Soap,Scammony, 
each, 14. 

. Fruit . 

. Leaves 

. Sclerot 

. Bark . 

. Root . 

. Root . 

) Root . 

. Logwood 

. Herb 

. Rhizome 

. Tuber 

. Bark 

. Root 

. Root 

. Seed 



Calabar bean 
Rhizome 
Wood 
Root . 
Seed . 
Root . 
Leaves 



Parts 
of Drug 

in 
1 part of 
Extract. 



5 
2 

5 
5 

10 

10 

6 

3 
6 



4 
4 
5 
5 
4 
3 
3 
4 
6 

7 
6 
6 
5 

5i 
10 
f i 

20 
IO 

25 

3 
10 

3 
3 



Dose of Drug. Dose of Extract. 



Grains. Gm. Grains. Gm 



I 
IO 
IO 

3 

10 

10 

30 

5 

3 



4 
2 

3° 
30 
20 

30 

60 

10 

6 

7 

15 
15 
i5 
i5 
3 



10 
5 

30 
3 

30 

30 



.06 
.65 
.65 
.2 
.65 
.65 
> # 

•3 
.2 



•25 
.12 

2. 

2. 

i-3 
2. 

4- 

.65 

•4 

•5 
1. 
1. 
1. 
1. 

.2 

.06 

.06 

.65 

•3 
2. 

.2 
2. 
2. 



1 
1 
2 
6 
6 
5 

IO 

20 

2} 



.OI2 

•32 

.12 

•03 
.06 
.06 

•3 
.12 

.03 



.06 

•03 

•4 

•4 

•3 

.65 

i-3 
.15 

.06 

.06 

.2 

.2 

.2 

.2 

.02 

.04 

.01 

.06 

.06 

.65 

•15 

•65 

.65 



ABSTRACTA— ABSTRACTS. 

A class of powdered extracts, prepared from the extracts by the 
addition of sufficient Milk Sugar to make the product represent 
one-half its weight of the crude drug, was official in the U. S. P. 
VI. (1880) under the title of Abstracts. 

The Abstracts have a uniform relation to the drug — viz. 1 grain 
represents 2 grains of the drug, just as the fluid extracts have the 
uniform relation of representing the drug measure for weight. 

In preparing an abstract the drug is exhausted, the extract 
obtained incorporated with its weight of Milk Sugar, the mixture 



HO A TEXT-BOOK OF MATERIA MEDICA. 

powdered, and enough Milk Sugar added to bring the product to 
one-half the weight of the drug employed. Abstracts must be pre- 
served in small, perfectly dry, and well-corked vials in a dry and 
cool place. 

Their uniformity alone should have favored the employment of 
Abstracts in preference to the Extracts, since they do not share the 
variability in strength of the extracts, the dose of the Abstract being 
exactly one-half that of the crude drug or Fluid Extract. This 
advantage was offset by the disadvantage that Abstracts are more 
bulky, and caused their deletion in the U. S. P. 1890. The Ab- 
stracts are therefore unofficial. 

The official Extracts of Jalap and of Nux Vomica have su- 
perceded the abstracts of these respective drugs in a more con- 
centrated and equally convenient form. Of the remaining nine 
Abstracts formerly official, Aconite, Belladonna, Conium, Digitalis, 
Hyoscyamus (Ignatia, superceded by Nux Vomica), Podophyllum, 
Senega, and Valerian, the five first mentioned, commonly but 
erroneously called the "narcotic extracts," may be prepared, in 
the powdered form, of such strength as to represent the same 
drug-strength as their respective official " solid extracts." 



Extractum Ferri Pomatum, N. F. — Ferri Malas Crudus (Fer~ 

rated Extract of Apples, Ph. Ger.). 
Extractum Glycyrrhiz^e Depuratum, N. F. — Succus Liqui- 

ritiae, Ph. Ger. (Purified Extract of Liquorice). 

OLEORESINS— OLEORESINS. 

To natural Oleoresins, derived as plant-exudations, belong the 
Turpentines and the Pitches. From similar exudations are ob- 
tained the Gum Resins, mixtures of Gum and Resins and sometimes 
Volatile Oils ; also the Balsams, which are Resins or Oleoresins 
associated with Benzoic or Cinnamic Acid. These are treated 
under their respective Drugs. 

The pharmaceutical Oleoresins are semi-liquid extracts, obtained 
by exhausting oleoresinous drugs with Ether. 

Ether extracts fixed and volatile oils from drugs, as well as resin; 
these principles constitute therefore the oleoresins, which some- 
times also contain other active matter in solution or suspension. 

The menstruum (Ether), being easily volatilized, is recovered by 
distillation ; it is sometimes superseded by Alcohol, which yields an 
extract very similar to that obtained with ether. 



EXTRACTIVE PREPARATIONS. Ill 

The six following are official : 

Dose. 
Oleoresina — , . , 

Aspidii; separates in two layers, 

to be mixed when used ... 1-2 drachms. 4.-8. 
Capsici ; separates fat, used only as 

corrective TT~i g ra i n - 0.01-0.005 

Cubebae; separates wax .... 1-2 grains. 0.06-0.1 

Lupulinae 2-3 grains. 0.1-0.2 

Piperis ; separates piperine, to be 

rejected 1-2 grains. 0.08-0.1 

Zingiberis -|— J grain. 0.02-0.01 

RESINS— RESINS. 

The official Resins may be divided into the (1) Natural Resins, 
(2) Resins obtained from Oleoresins by separating the Volatile Oil 
by distillation, and (3) the Pharmaceutical Resins, prepared by pre- 
cipitation. 

When a concentrated tincture of a resinous drug is poured into a 
large quantity of cold water, the resinous matter becomes insoluble 
and is precipitated ; this, after being washed, dried, and sometimes 
powdered, is termed a resin. 

Resins are usually soluble in alkalies and insoluble in acids 
(dilute) ; for this reason the water used for precipitation is some- 
times rendered slightly acid to favor the separation. 

The three following are official : 

Per cent, yield 

from Drug. Dose. Rep. Drug. 
Resina — , * , , ' , 

Jalapae 15 3 grains 0.2 20 grains 1.3. 

Podophylli 5 \ grain 0.03 10 grains 0.6. 

Scammonii 65 3 grains 0.2 5 grains 0.3. 

Resina and Resina Copaibae are obtained as residue in the dis- 
tillation of the respective Oleoresins, Turpentine and Copaiba. 
The natural Resins are obtained as exudates — e. g. R. Guaiaci. 

The terms resin, resinoid, and concentration are also applied to a 
class of preparations used by eclectic physicians, prepared by this 
general process with some modifications. (See U. S. and Am. Disp.) 

They are named after their respective Drugs with the ending in, 
as in Glucosides, and must not be confused with the latter. While 
the Glucosides are usually the active medicinal constituents repre- 
senting the drug, the resinoids, with the exception of those made 



H2 A TEXT-BOOK OF MATERIA MEDIC A. 

from drugs whose active principles are resins, such as Cimicifuga 
and Podophyllum, are more or less inert, unreliable mixtures, too 
indefinite in their composition and strength for medicinal use. 



SOLID MIXTURES FOR INTERNAL USE. 

Mixtures of Solids for internal use embrace the following 
classes of preparations : Powders, Effervescent Salts, Confections, 
Troches, Masses, and Pills. 

Powders are substances reduced to a fine pulverulent condition 
to favor their administration and solution or absorption. A powder 
may be simple, such as a powdered drug, Pulvis opii, or a pow- 
dered salt — i. e. Quinince sulphas ; or it may be compound, a mix- 
ture of several substances. 

Sparingly soluble substances, when finely powdered (impalpable) 
and thoroughly mixed by trituration in a mortar with some inert 
powder (diluent) such as Milk Sugar, are rendered more soluble, 
since a greater surface is exposed to the solvent action of the 
liquids of the body, and prompter and fuller effects are obtained. 
The potency of calomel, of the resins, and of alkaloids is in this 
way considerably increased within certain limits, but not to the 
unreasonable extent advocated by Homoeopathic pharmacy, in 
which this process is carried to a reductio ad absurdum. It is an 
excellent and convenient method for dispensing and administering 
the more potent agents, such as arsenous acid, mercury com- 
pounds, and the alkaloids. Substances triturated in this way have 
been called Triturations, for whose preparation the U. S. P. gives a 
general formula : 

Take of the substance, for example, Elaterin . . . I Gm< 
Milk Sugar, in fine powder 9 Gm. 

First thoroughly triturate the medicinal substance (Elaterin) 
with an equal weight of Milk Sugar, then add the remainder of the 
Milk Sugar, and mix thoroughly by trituration (for about ten 
minutes). 

Unless otherwise specified, triturations should be of the official 
strength — i. e. 10 per cent, of the drug. 

By the addition of about an equal weight of Alcohol to the 
triturate it becomes a soft mass, which, after being moulded into 



SOLID MIXTURES FOR INTERNAL USE. 113 

disks of about 1 grain (0.06) each, after the evaporation of the 
Alcohol, furnishes the so-called Tablet Triturates. These afford 
a convenient method of medication for such substances as are 
adapted to trituration, which is, however, confined, as indicated, 
to a comparatively limited number of agents. To represent in the 
form of these tablets every kind of medicinal agent of volatile cha- 
racter, or drugs otherwise susceptible to change through the inevi- 
table exposure to the atmosphere to which every such mixture is 
liable, is simply to invite error in practice. These tablets, more- 
over, with certain chemical substances, undergo chemical changes 
which render them entirely insoluble, and thus practically inert. 
In order to be effective and otherwise reliable, they should be pre- 
pared extemporaneously by the pharmacist, in order to ensure 
their solubility. 

They should always be dissolved in a little water before they 
are administered. 

When it is desired to obtain a mild and prolonged local effect 
of a medicinal agent in the mouth or throat, the substance is made 
into a soft mass {confection) with a diluent and excipient, Sugar and 
Mucilage, and flavor, and formed into round or oval-shaped disks, 
weighing from 8 to 30 grains (^ to 2 Gm.), called variously Lozenges, 
Troches, Tablets, and Pastils. 

Troches. — When these are allowed to dissolve slowly in the 
mouth the diluent serves as a vehicle for the medicinal agent, and 
a gradual prolonged effect is obtained upon the mucous surfaces. 
This form of medication is adapted only to astringents, antacids, 
expectorants, and stomachics consisting of substances not especi- 
ally disagreeable to the palate. 

Tablets, or Lozenges, are not intended to be swallowed, nor 
adapted to exceedingly volatile, caustic, irritant, or otherwise un- 
palatable substances. For ingestion, medicinal agents should be 
made into a Mass {inassa) with an excipient, and formed into small 
spheres, or balls, as a rule not over 5 grains (0.3) in weight, 
to be swallowed and slowly dissolved in the stomach or intestines. 
Such preparations are the so-called Pills (Pilulce, from pila, ball). 

PULVERES— POWDERS. 

The nine official Powders are impalpable mixtures of one or 
more active drugs, usually with some nearly inert substance, such 
as Sugar, as a diluent, and Aromatics. 

They are made by trituration. 



114 A TEXT-BOOK OF MATERIA MEDICA. 

Pulvis — Gm. in ioo. 

Antimonialis (James') . calc. phos. 67; antimon. oxide 33. 

Aromaticus .... cinnamon (Ceylon), ginger, each 35. 

cardamom (seed), nutmeg, each 15. 

Cretae Compositus . acacia p. 20; sugar 50; prep, chalk 30. 

Glycyrrhizae Compositus . . . senna 18; glycyrrhiza 24. 

fennel oil 0.4; sulphur, washed, 8; sugar 50. 

Ipecacuanhae et Opii . . . ipecac, opium pulv., each 10. 

(Dover's Powder) sugar of milk 80. 

Jalaps Compositus .... potass, bitartrate 65 ; jalap 35. 

Rhei Compositus . magnesia 65 ; ginger 10; rhubarb 25. 

In 60 grains. 
Pulv. Morphinae Compositus . . camphor 10; morphine 

(Tulley's Powder) sulph. 1. 

calcium carb., precip. ; glycyrrhiza p., each 20. 

For 12 pow . ; in each, grains. 

Effervescens Compositus . (Seidlitz Powder) 

potassium and sodium tartrate 93 Gm. 120 
sodium bicarbonate 31 Gm. 40 

acid tartaric. 27 Gm. 35 

Many methods are in use for the purpose of disguising the taste 
of disagreeable remedies in the powder form. Of these the most 
elegant and effective method is that of enclosing the powder in a 
cachet or wafer. Originally wafers were made of starch-paste in 
thin sheets ; a piece about 0.5 dcm. (2 inches) square, immersed 
in water for a minute, being placed in a spoon, the powder poured 
into it, and then enwrapped by folding up the edges and swallowed 
with a little water. The cachets or " konseals " are wafer-disks 
consisting of two concentric halves, one of which is filled with the 
powder, and the other half attached by moistening the edge and 
pressing the edges together by means of various devices. These 
cachets are of three sizes, the largest holding 5 grains (0.3) Quinine 
Sulphate. After one minute's immersion in water they can be 
swallowed without any effort. 

Unofficial Powders of the N. F. 
Pulvis — 

AcACiiE Compositus (Pulvis Gummosus, Ph. Ger.). 
Acetanilidi Compositus. — Containing 50 per cent. Acetan- 






SOLID MIXTURES FOR INTERNAL USE. 1 15 

Pulvis — 

ilid, 2 per cent. Caffeine, with Tartaric Acid and Sodium 
Bicarbonate. 

Aloes et Canell^e (Hiera Picra). 

Amygdalae Compositus (Almonds Comp.) — A mixture of 
Sweet Almond, Sugar, and Acacia, in fine powder; 180 
grains (10 Gm.), triturated with Water, yield about 4 fluid- 
ounces (119 Cc.) of Emulsum Amygdalae. 

Anticatarrhalis (Catarrh Snuff.) — Hydrochlorate of Mor- 
phine, 1 part ; Acacia, 60 parts ; Subnitrate of Bismuth, 1 80 
parts, in fine powder. 

Catechu Compositus (Compound Powder of Catechu, Ph. Br.). 
— Catechu, 4 parts ; Kino, 2 parts ; Krameria, 2 parts ; 
Cinnamon, 1 part; Nutmeg, 1 part. 

CreTjE Aromaticus. — A mixture of Cinnamon, Saffron, Nut- 
meg, Cloves, Cardamon, prepared Chalk, and Sugar. 

Cret,e Aromaticus cum Opio. — Aromatic Powder of Chalk, 
with 1 grain (0.06) of powdered Opium, in 40 grains (1.5) of 
the mixture. Official in the Ph. Br. 

Hydrargyri Chloridi Mitis et Jalaps (Calomel and 
Jalap). — A mixture of Mild Chloride of Mercury, 10 grains 
(0.6), and Jalap, 20 grains (1.3). 

When " Calomel and Jalap " is prescribed for an adult, without any specifi- 
cation of quantities, the N. F. recommends that the above mixture be dispensed 
as one dose. 

Iodoformi Compositus (Iodoform and Naphthalin). — A mixture 
of Iodoform, 2 parts ; Boric Acid, 3 parts ; Naphthalin, 5 
parts ; with Oil of Bergamot, in fine powder. 

This powder is used in many cases where a diluted preparation of Iodo- 
form, for external purposes, is desired. The odor is masked both by the Oil 
of Bergamot and by the Naphthalin. 

Kino Compositus. — A mixture of Kino and Cinnamon, with 1 
grain (0.06) of Powdered Opium in each 20 grains (1.3). 

Myrice Compositus (Composition Powder). — A mixture of 
Bayberry, Ginger, Capsicum, and Cloves. 

Pancreaticus Compositus (Peptonizing Powder). — A mixture 
of 20 parts Pancreatin and 80 parts Sodium Bicarbonate; 
25 grains will peptonize 1 pint of milk. 

Pepsini Compositus (Pulvis Digestivus). — A mixture of Pep- 
sin, Pancreatin, Diastase, Lactic and Hydrochloric Acids, 
with Milk Sugar to represent the gastric juice. 



ii6 A TEXT-BOOK OF MATERIA MEDICA. 

Pulvis — 

Rhei et Magnesia Anisatus (Compound Anise Powder.) — ■ 
A mixture of Rhubarb, Heavy Magnesia, and Oil of Anise. 

Talci Salicylicus (Salicylated Powder of Talcum). — A mix- 
ture of Talcum with 3 per cent. Salicylic Acid and 10 per 
cent. Boric Acid, in fine powder. 

Powders are usually directed to be divided into papers {char- 
tula) ; thus, for example, a formula for a prescription would be — 

Ify Hydrargyri Chloridi Mitis . . 1. 

Sacchari Lactis 9. 

Misce cum trituratione et in chartulis No. x. divide. 

Encapsuling powders by filling them in gelatin capsules is a 
very convenient and elegant form of administration. No mixture 
which is desired to be given in the form of powder, however, should 
be made into a mass for facilitating the encapsuling process — 
a custom too frequently adopted. Many substances, especially 
Bismuth Subnitrate and Calomel, become exceedingly hard and 
quite insoluble when made into a mass. No dispenser should 
assume the prerogative of changing the form of medication pre- 
scribed. 

SALES EFFERVESCENTES EFFERVESCENT SALTS. 

These are granulated mixtures of Salts with Sugar and Sodium 
Bicarbonate and Tartaric Acid, which decompose when the Salt is 
dissolved in Water and furnish agreeable aerated draughts. 

The following are official, the strength indicated being that con- 
tained in 90 grains (6 Gm.), a heaped teaspoonful being the ordinary 
dose, dissolved in about 6 fluidounces (180 Cc.) of water: 

Caffeina Citrata Effervescens caffeine 0.06 

Lithii Citras Effervescens .... lithium citrate 0.06 

Magnesii Citras Effervescens . magnesium citrate 1.0 

Potassii Citras Effervescens . . . potassium citrate 3.0 

Effervescent Salts {Granular), N. F. 

The strength given for these is the quantity contained in 90 
grains (6 Gm.), which represents about the quantity of these Salts 
contained in a heaped teaspoonful of ordinary size, the average 
dose. 



SOLID MIXTURES FOR INTERNAL USE. 117 

Ferri et Quinine Citras Effervescens, i grain (0.06) Citrate 
of Iron and Quinine. 

Ferri Phosphas Effervescens, 2 grains (0.12) Phosphate of Iron. 

Potassii Bromidum Effervescens, 20 grains (1.3) Potassium Bro- 
mide. 

Potassii Bromidum cum Caffeina, 10 grains (0.6) Potassium Bro- 
mide and 1 grain (0.06) Caffeine. 

Sal Carolinus Factitius Effervescens (Effervescent Carlsbad 
Salt, artificial). — A solution of about 87 grains (5.5) in 6 fluid- 
ounces (178 Cc.) of Water represents an equal volume of 
Carlsbad Water (Sprudel). 

Sal Kissingensis Factitius Effervescens (Effervescent Kissingen 
Salt, artificial). — A solution of about 80 grains (5 Gm.) in 6 fluid- 
ounces (178 Cc.) represents an equal volume of Kissingen 
Water (Rakoczy). 

Sal Vichyanus Factitius Effervescens (Effervescent Vichy 
Salt, artificial). — A solution of about 57 grains (4 Gm.) in 6 
fluidounces (178 Cc.) of Water represents an equal volume of 
Vichy Water (Grand Grille). 

Salts {Non-effervescent). 

Sal Carolinus Factitius. — In two forms, Dry (Ph. Ger.) and 
Crystalline. A solution of about 16 grains (1 Gm.) of the Dry 
(27 grains (1.8) of the Crystalline) in 6 fluidounces (178 Cc) 
of Water represents an equal volume of Carlsbad Water 
(Sprudel). 

Sal Kissingensis Factitius. — A solution of about 24 grains (1.5) 
in 6 fluidounces (178 Cc) of Water represents an equal volume 
of Kissingen Water (Rakoczy). 

Sal Vichyanus Factitius. — A solution of about 14 grains (1 Gm.) 
in 7 'fluidounces (207 Cc.) of Water represents an equal volume 
of Vichy Water (Grand Grille). 

CONFECTIONES— CONFECTIONS. 

Confections may be defined as flavored masses wherein the 
adhesive substance is Sugar in large proportions, serving as a 
vehicle for masking the taste of the drug. 

Confections, when made by beating a fresh drug, first reduced 
to pulp with sugar until of the proper consistence, are termed 
conserves. When made from powders or extracts they are called 
electuaries. 



n8 



A TEXT-BOOK OF MA TERIA MEDICA. 



Only one representative of each class is official : 

Gm. in 100 Cc. 

Confectio Rosae rose water i6, red rose 8 

(Conserve of Rose) sugar 64, honey 12 

c oil coriander 0.5, senna 10 

Confectio Sennae . < cassia fistula 16, fig 12, tamarind 10 
(Electuar. Sennce) \ prune 7, sugar 55, water to 100, 

The Confection of Senna is a very agreeable laxative, especially 
adapted for constipation in women and children. It is exceedingly 
agreeable to the taste. 

TROCHISCI— TROCHES. 

Troches, or lozenges, are confections made into various forms 
and then dried. 

The vehicle or excipient consists of Powdered Gum Tragacanth 
or Sugar with flavoring — in some cases orange flower water, in 
others tolu, nutmeg, vanilla, etc. 

The active ingredients are mixed with the diluent or vehicle and 
made into a plastic mass with the particular excipient, Water or 
Syrup. The mass is rolled out to the requisite thickness, and the 
disks formed by cutting through it with a punch or troche-cutter. 
The troches are then dried by exposure. 

The size and weight of the troche are regulated by the thickness 
of the mass and the diameter of the cutter. 

The 15 official Troches vary in weight from Gm. 0.5 to 1.5. 



Trochisci — 

Acidi Tannici .... 
Ammonii Chloridi . . 

extract glycyrrhiza 25. 

Catechu 6. 

Cretse 

Cubebse .... oleoresin 

extract glycyrrhiza 

sassafras oil 

Ferri . . . ferric hydrate 

Glycyrrhizse et Opii 

ext. glycyrrhiza 
powd. opium 





Active Dr 


UG. 


Gm. in 


Gm. in 


Grains 


in 


100 


each 


each 




Troches. 


Troche. 


Troche 




6. 


O.06 


I 


Orange flor. 


10. 


O.I 


I* 


Tolu. 


25- 


O.25 


4 




6. 


O.06 


1 


Orange flor. 


25. 


O.25 


4 


Nutmeg. 


4- 


O.O4 


1 




25. 


0.25 


4 




1. 


O.O I 


1 

"6 




30. 


0.3 


5 


Vanilla. 


i5- 


O.I5 


**' 


Anise. 


0.5 


mg.5. 


h 





Gm. in 


Gm. in 


Grains 


in 


IOO 


each 


each 




Troches. 


Troche. 


Trocht 




2. 


0.02 


i 


Orange. 


6, 


O.06 


I 


flor. 


i. 


O.O I 


1 


Peppermint. 


0.16 


mg. 16 


1 
"5T 


Gaultheria. 


0.50 


"5. 


1 
12 




30. 


0.3 


5 


Lemon. 


3- 


0.3 


i 


Orange flor. 


20. 


0.2 


1 
3 


Nutmeg. 


20. 


0.2 


1 
3 


Ginger. 



SOLID MIXTURES FOR INTERNAL USE. 1 19 

Active Drug. 



Trochisci — 

Ipecacuanhas 2. 

Krameriae .... extract 
Menthae Piperitae . . .oil 
Morphinae . morphine sulph. 
et Ipecac, powd. ipecac 
Potassii Chloratis .... 

Santonini 

Sodii Bicarbonatis .... 
Zingiberis . . tinct. ginger 

Lozenges of Peppermint, Lemon, Musk, Vanilla, and Gaultheria 
may readily be prepared by saturating sugar lozenges with the 
respective essences or tinctures and permitting the alcohol to 
volatilize. 

MASSES— MASSES. 

Masses are plastic mixtures of pilular consistence. They are 
made by incorporating the drug with adhesive substances, by chem- 
ical reaction, and sometimes by both processes. 

The Masses are intended to be formed into pills whenever they 
are to be dispensed. They are therefore often called Pil, Pilules, 
instead of Massa. There are only three official : 

Massa Copaibae .... water 1, magnesia 6, copaiba 94. 

The Copaivic Acid combines with the magnesia, forming mag- 
nesium copaivate of pilular consistence. This is also known as 
" solidified copaiba." 

Massa Ferri Carbonatis f sodium carb., ferrous sulph., each 1 00. 
(Vallet's Mass) \ honey 38, sugar 25, syrup to 100. 

By double decomposition between the Ferrous Sulphate and 
Sodium Carbonate ferrous carbonate is formed, which is incorpo- 
rated with Honey and Sugar to prevent oxidation and to render 
the mixture a plastic mass. The Pill of Ferrous Carbonate (Pil 
Blaudii) is preferable to this mass, as in the pill the ferrous car- 
bonate is better protected against oxidation. 

Massa Hydrargyri . glycyrrhiza 5, althaea 25, mercury 33. 
(Blue Mass) glycerin 3, honey of rose 34. 



120 A TEXT-BOOK OF MATERIA MEDICA. 

The mercury is extinguished by trituration with the rose honey 
and glycerin and the powdered glycyrrhiza ; the other ingredients 
are then incorporated. The usual dose is from 5 to 10 grains 
(0.3-0.6). 

PILULE— PILLS. 

Pills are spherical, more or less soluble masses of medicinal 
substances rendered cohesive \ plastic, and firm in consistence by the 
addition of some substance (usually inert) termed an excipient. 

The kind of excipient employed varies with the nature of the 
medicinal substance. As a general rule, such substances are chosen 
as give to the mass, with the smallest proportion, the greatest plas- 
ticity, and also best preserve the spherical shape of the pills. The 
excipient must also, unless the contrary be directed for especial 
purposes, be indifferent in character, to avoid change in the medic- 
inal agents. 

Soluble substances are rendered adhesive by the action of sol- 
vents, and require, according to their solubilities, the addition of 
some liquid such as Water, Alcohol, Glycerin, etc. Others require 
the addition of adhesive substances, such as Syrup, Mucilage, Glu- 
cose, Glycerite of Starch or Tragacanth, etc. 

Drugs adapted for dispensing in the form of pills maybe divided 
as follows : 

(1) The official Masses, Extracts, and Scaled Salts. 

Masses and extracts, being of pilular consistence, require no 
addition except when hard or dry ; Water should then be incor- 
porated to restore them to their original form. Abstracts and 
powdered extracts are best made into a mass with Water. 

(2) Vegetable Powders in which the dose does not exceed five 
grains. 

With these adhesive excipients are indicated, such as Syrup, Mu- 
cilage, Glycerite of Tragacanth, and Glucose. The last mentioned 
answers the requirements better than most other substances. Con- 
fection of Rose and Extracts of Gentian, Glycyrrhiza, and Taraxa- 
cum are also used when their color is not objectionable. 

(3) Salts not too deliquescent, and Alkaloids. 

Excipients for these must combine adhesive and absorbent quali- 
ties. They are first triturated with a dry powder — e. g. Althaea, 
Glycyrrhiza, or Milk Sugar — and then mixed with the adhesive 
substance — viz. Glucose or Glycerite of Starch or Tragacanth. 

No excipient must be used that will give to the mass a color 
different from that of the medicinal ingredients (the base). 



SOLID MIXTURES FOR INTERNAL USE. 12 1 

(4) Volatile Oils and Oleoresins. 

The quantity of these when dispensed in pills being compara- 
tively large, it is necessary to add some light absorbent substance, 
such as Magnesia or Starch, to which is added the adhesive 
material. The practice of adding wax or resin to oils is not to be 
recommended except as a last resort, since they tend to render the 
pill insoluble. 

(5) Resins and Gum Resins. 

These form an adhesive mass by the addition of a little Alcohol, 
with which more bulky excipients, such as Soap, may be incorpo- 
rated to preserve the shape of the pill. 

(6) Salts of the Cinchona Alkaloids, Quinine and Cinchonidine 
Sulphates, etc. 

These are often prescribed in pill form in large doses, and it is 
therefore desirable to reduce their bulk. For this purpose dilute 
Sulphuric Acid or Tartaric Acid is added in small quantity, which 
acts as a solvent upon the salt, thereby converting it into a mass. 
This mass is incorporated with a little Glycerite of Starch, other- 
wise it soon loses its plasticity; it must therefore be rolled into 
pills as soon as formed. 

(7) Substances easily decomposed by organic matter. 
Potassium Permanganate and Silver Nitrate are quickly " re- 
duced " when incorporated with the excipients usually employed. 

These should be mixed with an inorganic diluent not affected 
by them, such as Kaolin, Pipe Clay, or Fullers' Earth, and made 
into a mass with Water, Petrolatum, Resin Cerate, etc. 

In order to disguise the bitter or otherwise disagreeable taste 
of pills, they are usually coated with sugar or gelatin. These 
coated pills are often objectionable on account of the coating, or 
the pill itself, becoming quite insoluble. When a coated pill is 
desired, it should be freshly made and enclosed in a gelatin capsule 
of the smallest size. Pills may also be coated extemporaneously 
by rolling them on a piece of filter-paper saturated with Mucilage 
of Acacia, and then in powdered Milk Sugar. 

Keratin-coated pills are designed for solution in the duodenum, 
the pills being dipped in a solution of Keratin prepared from horn 
shavings treated with pepsin and hydrochloric acid. 

Concentric pills are made up of concentric layers of different 
ingredients, intended to dissolve and become active at various 
stages in their passage through the intestinal tract. 

The following 1 5 Pills are official : 



122 



A TEXT-BOOK OF MA TERIA MEDICA. 







IN EACH. 




PlL.UL.iE. 


Gm. 
for ioo. 






Excipient. 












eg. 


grains. 




Aloes aloes purif., soap, each 


J 3 


l 3 


2 


Glyc. water. 


Aloes et Asafcetidae . aloes, asafcetida, soap, each 


9 


9 


xl 

2" 


« 


Aloes et Ferri . . aloes, iron sulph., arom. powder 


7 


7 




Conf. rose. 


Aloes et Mastiches (Dinner Pill) .... aloes 


13 


n 


2 




mastic 


4 


4 


2 
3" 




red rose 


3 


3 


1 


Water. 


Aloes et Myrrhae aloes 


13 


13 


2 




myrrh 


6 


6 


I 




arom. powder 


4 


4 


2 
"3 


Syrup. 


Antimonii Comp antimony, sulphurated 


4 


4 


1 




(Plummer's Pills) mild mercurous chlor. 


4 


4 


| 




guaiac 


8 


8 


J i 


Castor oil. 


Asafcetidae asafcetida 


20 


20 


3 


Soap. 




8 


8 


*3" 




mild mercurous chloride 


6 


6 


I 




extract of jalap 


3 


3 


1 
2 




gamboge 


i-5 


1-5 


1 


Water. 


Catharticae Vegetabiles . . . ext. colocynth comp. 


6 


6 


I 




exts. hyoscyam., jalap, each 


3 


3 


1 
2 




ext. leptandra, res. podophyll. 


i-5 


1-5 


1 




oil peppermint 


o.8 


0.8 


1 
"8 


Water. 


Ferri Carbonatis ferrous sulphate 


16 


6 






(Ferruginous, Chalybeate, Blaud's) potass, carb. 


8 








sugar 4; tragac, althaea, each 


i 






Glyc. water. 


Ferri Iodidi 1 reduced iron 


4 


*6* 


I 




iodine 


5 








glycyrrh., sugar, each 


4 








ext. glycyrrh., acacia, each 


i 






Water. 


Opii soap 2 ; opium pulv. 


6-5 


6.5 


I 


« 


Phosphori 2 phosphorus 


0.06 


0.06 


T(fo 




althaea, acacia, each 


6 






Glyc. water. 


Rhei soap 6; rhubarb 


20 


20 


3 


Water. 


Rhei Comp rhubarb 


13 


13 


2 




aloes 


IO 


10 


"1 




myrrh 


6 


6 






oil peppermint 


o.5 


• • 




u 



Unofficial Pills of the National Formulary. 
When a large number of pills are to be prepared in accordance 
with the given proportions, and the quantities of the ingredients 
are to be determined by multiplying with the number of pills re- 
quired, it is recommended that the nearest whole number, or near- 
est convenient fraction, in each case, be chosen. 

Pilulae— 

Ad Prandium (Dinner Pills). — When " Dinner Pills," under 
this or some other equivalent name, are prescribed without 
further specification, the National Formulary recommends 
that the Pilulae Aloes et Mastiches of the U. S. P., also 
called " Lady Webster's Dinner Pills," be dispensed. 

1 Coated with ethereal solution of Balsam Tolu. 2 Phosphorus dissolved in Chloroform. 



SOLID MIXTURES FOR INTERNAL USE. 123 

Pilulae— 

Of other combinations bearing similar names or used for 
similar purposes, the following appear to be those most 
commonly in use : 

Chapman's Dinner Pill. — Aloes, Mastic, each, grains \\ 

(0.1); Ipecac, grain 1 (0.06); Oil of Fennel, grain \ (0.015). 

Cole's Dinner Pill. — Aloes, Mass of Mercury, and Jalap, 

each, grains 1^- (0.075) ; Ant. and Potas. Tartrate, grain -fa 

(0.0013). 

Hall's Dinner Pill. — Aloes, Ext. of Glycyrrhiza, Soap, 
and Molasses, each, grain 1 (0.06). 

Aloes et Podophylli Composite (Janeway's Pills). — Aloes, 
grain 1 (0.06) ; Resin Podophyllum, grain \ (0.03) ; Ext. 
Bellad. Ale, Ext. Nux Vomica, each, grain \ (0.015). 

Aloini Composite. — Aloin, grain \ (0.03) ; Resin Podophyl- 
lum, grain \ (0.01); Ext. Belladonna, grain \ (0.015). 

Aloini, Strychnine et Belladonna. — Aloin, grain \ (0.0 1 
Gm.) ; Strychnine, alkaloid, grain y^- (0.0005 Gm.) ; Alco- 
holic Extract of Belladonna, grain \ (0.008 Gm.). 

Aloini, Strychnine et Belladonna Composite. — Aloin, 
grain \ (0.012); Ext. Bellad. Ale, grain \ (0.008 Gm.); 
Strychnine, alkaloid, grain T fg- (0.0005) ; Ext. Rham. Pursh., 
grain \ (0.03). 

Antidyspeptice. — Strychnine, alkaloid, grain -fa (0.0014) ; 
Ipecac, Ext. Bellad. Ale, each, grain -fa (0.006) ; Mass of 
Mercury, Ext. Colocynth. Comp., each, grains 2 (0.13). 

Antineuralgice. — I. Gross' Antineuralgic Pills: Quinine 
Sulphate, grains 2 (0.13); Morphine Sulphate, grain fa 
(0.003); Strychnine, alkaloid, grain ^ (0.002); Arsenous 
Acid, grain fa (0.003) ; Ex. Aconite Leaves (U. S. P. 1870), 
grain | (0.03). 

When " Antineuralgic Pills," or " Neuralgia Pills," with- 
out other specifications, are prescribed, it is recommended 
that the above preparation be dispensed. Sometimes the 
Morphine is directed to be omitted. 

2. Brown-Sequard's Antineuralgic (or Neuralgia) Pills: 
Extracts of Hyoscyamus and Conium, each, grain f (0.04) ; 
Extracts of Ignatia and Opium, each, grain \ (0.03) ; Ext. 
Aconite Leaves, grain \ (0.02) ; Ext. Stramonium, grain \ 
(0.01); Ext. Indian Cannabis, grain \ (0.015); Ext. Bellad. 
Ale, grain \ (0.0 1). 



124 A TEXT-BOOK OF MATERIA MEDIC A. 

Pilulae— 

Antiperiodicle (Warburg's Pills). — i. With Aloes : Aqueous 
Extract of Aloes, grain I (0.06) ; Rhubarb, grain \ (0.03) ; 
Elecampane, Saffron, Fennel, each, grain \ (0.015); Zedo- 
ary, Cubebs, Myrrh, White Agaric, Camphor, each, grain \ 
(0.008) ; Quinine Sulphate, grains i-| (0.085) ; Extract of 
Gentian, a sufficient quantity. 

2. Without Aloes : The same formula as above, with omis- 
sion of the Aqueous Extract of Aloes. These pills have 
been introduced for the purpose of facilitating the adminis- 
tration of Warburg's Tincture in a solid form. When 
" Warburg's Pills " or " Pills of Warburg's Tincture " are 
prescribed, without further specification, those containing 
Aloes are recommended to be dispensed — those without 
Aloes only when they are expressly demanded. 

Each Warburg's Pill represents about I fluidrachm (4 
Cc.) of Warburg's Tincture. (See Tinctura A?itiperiodica) 

Colocynthidis Composite (Pilulse Cochia). — Extract of Colo- 
cynth, grain ■$• (001); Aloes, Resin of Scammony, of each, 
grains 2 (0.13) ; Oil of Cloves, min. \ (0.015). 

Colocynthidis et Hyoscyami. — Extract of Colocynth, grain 
■fa (0.006) ; Aloes, Resin of Scammony, Ext. Kyoscyamus, 
each, grains r-J- (0.1); Oil of Cloves, min. ^ (0.0 1). 

Colocynthidis et Podophylli. — Compound Extract of Colo- 
cynth, grains 1^- (0.16); Resin of Podophyllum, grain \ 
(0.015). 

Ferri Composite (U. S. P. 1880). — Myrrh, 1^ grains (0.1); 
Ferrous Sulphate, Sodium Carbonate, each, f grains (0.048). 

Galbani Composite (U. S. P. 1880). — Galbanum, Myrrh, 
each, i-l- grains (0.1); Asafcetida, \ grain (0.03). 

Glonoini (Nitroglycerin). — Spirit of Glonoin (1 per cent), 
Athaea, each, grains 200 (13.0); Confection of Rose, a suf- 
ficient quantity. Make a mass and divide it into two hun- 
dred (200) pills. Each pill contains fa-^ grain (0.0007) °f 
Glonoin (Nitro-glycerin). 

Laxative Post-partum (Barker's). — Ext. Colocynth. Comp., 
grains if (0.1) ; Aloes, grain f (0.05) ; Res. Podoph., Ipecac, 
each, fa grain (0.005) J Ext. Nux Vomica, fa grain (0.03) ; 
Ext. Hyoscyamus, ij grains (0.8). 

This is the formula generally employed by Dr. Fordyce 
Barker, except where special circumstances render modi- 



SOLID MIXTURES FOR INTERNAL USE. 125 

Pilulae— 

fications necessary. The formula usually quoted in manu- 
facturers' lists and some formularies is not correct. 

Metallorum (Metallorum Amarse). — Reduced Iron and 
Quinine Sulphate, each, grain 1 (0.06) ; Strychnine and Ar- 
senous Acid, of each, grain -fa (0.003). 

Aitken's Tonic Pill is a similar combination : 

Reduced Iron, grain -| (0.04); Quinine Sulphate, grain 1 
(0.06); Strychnine, Arsenous Acid, each, grain fa (0.0012). 

Opii et Camphors. — Powdered Opium, 1 grain (0.06) ; Cam- 
phor, grains 2 (0.13). 

Opii et Plumbi. — Powdered Opium and Acetate of Lead, 
each, grain 1 (0.06). 

Podophylli, Belladonna et Capsici (Squibb's Podophyllum 
Pills). — Resin Podophyllum, grain J (0.015); Capsicum, 
grain \ (0.03) ; Ext. Bellad. Ale, grain \ (0.008) ; Sugar of 
Milk, grain 1 (0.06) ; Acacia, Glycerin, and Syrup, each, 
a sufficient quantity. 

Quadruplices (Ferri et Quininae Compositae). — Ferrous Sul- 
phate, Quinine Sulphate, Aloes, each, grain 1 (0.06) ; Ext. 
Nux Vomica, grain \ (0.015); Ext. Gentian, sufficient. 

Triplices (Triplex). — Aloes, grains 2 (0.13); Resin Podo- 
phyllum, grain \ (0.015); Mass of Mercury, grain 1 (0.06). 
When Pilula Triplex, under this name or some equiva- 
lent, is prescribed without further specification, the N. F. 
recommends that the above preparation be dispensed. A 
formula devised by John W. Francis is also in use : 

2. Francis's Triplex Pill. — Aloes, Scammony, Mass of 
Mercury, of each, grain £ (0.05) ; Croton Oil, fa min - (o- 00 3) J 
Oil of Caraway, grain \ (0.015); Tincture of Aloes and 
Myrrh, a sufficient quantity. 

UNOFFICIAL FORMS OF MIXTURES OF SOLIDS FOR INTERNAL 

USE. 
Granules are small pills, less than 1 grain (0.06) in weight, 
usually sugar-coated and containing alkaloids and other active 
drugs. 

Parvules are identical with granules. They are usually colored 
red or pink. 

Globules (Orbiculce) are sugar pellets to be saturated with alco- 
holic solutions of medicinal agents, chiefly in Homoeopathy. 



126 A TEXT-BOOK OF MATERIA MEDICA. 

Compressed Pills are made by compressing powders into disks 
not exceeding 5 grains (0.3) in weight, without any excipient. 

Friable Pills are made by aggregation, spreading the powdered 
mixture upon nuclei or sugar granules in a revolving pan until the 
pills are formed. 

Bolus is the name given to pills exceeding 5-10 grains (0.3-O.6) 
in weight, used in veterinary practice. A sugar-coated bolus is 
called a Dragee. 

Rotulce are disk-shaped forms of sugar about I \ grains (0.1) in 
weight, which may be flavored with alcoholic solution (spirits). 

Bacilli are cylindrical sticks, a form of lozenge (Licorice). 

Lamellce, thin squares of gelatin in which the active agent has 
been incorporated, intended for solution in the eye. 



PREPARATIONS FOR EXTERNAL USE. 

To this group belong the liquid preparations : Liniments, 
Oleates and Collodions, and the mixtures of solids: Ointments, 
Cerates, Suppositories, Plasters, and Papers. The Vehicle, some- 
times incorrectly called the " base," consists chiefly of fatty sub- 
stances which serve as protectives or facilitate absorption. The 
Collodions are, however, an exception. 

The solid mixtures may be classified according to their fusi- 
bility, or melting-points, because their therapeutic uses, as well as 
their pharmaceutical forms, are through this quality respectively 
determined. 

Ointments fuse at the body-temperature, and therefore produce 
an emollient effect, or induce absorption of the medicinal substance 
by the system. They are applied by rubbing or inunction. 

Cerates have a higher fusing-point, due to Wax they contain ; 
the medicinal agent is not so readily absorbed, and they are there- 
fore used to produce local effects, being spread on cloth and applied 
as dressings. 

Suppositories have the same fusibility as cerates, and may be said 
to be cerates intended for application to the orifices of the body, both 
for absorption and local effect. 

Plasters have a still higher fusibility; they do not melt, but 
become adhesive by the body-temperature, and are intended to 
produce local effects and afford mechanical suppoi't to the parts 
affected. » 



PREPARATIONS FOR EXTERNAL USE. 127 

The fusibilities of these various preparations are likewise gov- 
erned by the respective vehicles employed. 

LINIMENTA— LINIMENTS. 

The Liniments are liquid preparations for external use, consist- 
ing of solutions of oily or resinous constituents in Alcohol or Oils, 
or mixtures of liquid Soaps. The nine official Liniments are 
prepared by simple admixture or solution. 
Linimentum — 

Ammoniae . . cotton seed oil 60 Cc. ; ammonia water 35 Cc. ; 

alcohol 5 Cc. 
Belladonnse . . . fl. ext. belladonna 95 Cc. ; camphor 5 Gm. 
Calcis (Carron Oil) . . linseed oil 50 Cc; lime solution 50 Cc. 
Camphorae .... cotton seed oil 80 Gm.; camphor 20 Gm. 
Chloroformi .... soap liniment 70 Cc. ; chloroform 30 Cc. 

Saponis camphor 4.5, soap 7, 

rosemary oil 1 ; alcohol 75 ; water, to 100 Cc. 

Saponis Mollis, alcohol 35 Cc; lavender oil 2; soft soap 65 Gm. 

Sinapis Comp. . . . fl. ext. mezereum 20; mustard oil, vol. 3, 

camphor 6; castor oil 15 ; alcohol, to 100 Cc. 

Terebinthinse . . resin cerate 65 Gm.; turpentine oil 35 Gm. 

Unofficial Liniments of the National Formulary. 
Linimentum — 

Aconiti et Chloroformi. — Tincture of Aconite, Chloroform, 

each, 2 fluidounces (60 Cc.) ; Soap Liniment, 12 fluidounces 

(355 Cc). 
Ammonii Iodidi. — Iodine, 30 grains (2.) ; Oil of Rosemary, 

Oil of Lavender, each, no minims (7 Cc); Camphor, 220 

grains (15.); Water of Ammonia, if fluidounces (50 Cc.) ; 

Alcohol, enough to make 16 fluidounces (473.17 Cc). On 

standing, it becomes colorless. 
Cantharidis (U. S. P. 1880). — Oil of Turpentine containing 

15 per cent, of Cantharides. 

Iodi (similar to Ph. Br.). — Iodine, 900 grains (60.) ; Potassium 
Iodide, 360 grains (24.); Glycerin, \ fluidounce (15 Cc.) ; 
Water, 1 fluidounce (30 Cc.) ; Alcohol, enough to make 

16 fluidounces (473.17 Cc). 

Opii Compositum (Canada Liniment). — Tincture of Opium, 1^ 
fluidounces (45 Cc.) ; Camphor, 120 grains (8.); Alcohol, 4 
fluidounces (118 Cc.) ; Oil of Peppermint, 180 minims 



128 A TEXT-BOOK OF MATERIA MEDICA. 

Linimentum — 

(12 Cc); Water of Ammonia, 6 fluidounces (180 Cc); 
Oil of Turpentine, enough to make 16 fluidounces 
(473.17 Cc.). 

Plumbi Subacetatis (U.S. P. 1880). — Solution of Lead Sub- 
acetate, 35 parts; Cotton Seed Oil, 65 parts. 

Saponato-camphoratum (Opodeldoc; Solid Opodeldoc). — 
White Castile Soap, \\ ounces (45.); Camphor, j- ounce 
(15.); Alcohol, 20 fluidounces (592 Cc); Oil of Thyme, 30 
minims (2 Cc.) ; Oil of Rosemary, 60 minims (4 Cc.)-; Water 
of Ammonia, Fort, 1 fluidounce (30 Cc). 

Terebinthin^e Aceticum (Linimentum Album., Stokes' Lini- 
ment ; St. John Long's Liniment). — Oil of Turpentine, 3 
fluidounces (89 Cc.) ; Fresh Egg, 1 ; Oil of Lemon, 60 
minims (4 Cc.) ; Acetic Acid, 300 minims (20 Cc) ; Rose 
Water, 2\ fluidounces (75 Cc). 

Tiglii (Linimentum Crotonis, Ph. Br.). — Croton Oil, 2 fluid- 
drachms (8 Cc); Oil of Cajuput, 7 fluidrachms (27.5 
Cc). 

Tiglii Compositum. — Croton Oil, 1 fluidounce (30 Cc); Oil 
of Sassafras, 1 fluidounce (30 Cc); Oil of Turpentine, 1 
fluidounce (30 Cc.) ; Oil of Olive, 2 fluidounces (60 Cc). 

LOTIONES— WASHES. 
Lotio — 

Adstringens (Warren's Styptic). — A mixture of Sulphuric 

Acid, Oil of Turpentine, and Alcohol. 
Flava (Yellow Wash, Aqua Phagedaenica Flava, Ph. Ger.). 
— Corrosive Mercuric Chloride, 24 grains (1.5), in Lime 
Water, 16 fluidounces (473 Cc). 
Nigra (Black Wash; Aqua Phagedaenica Nigra, Ph. Ger.). 
— Mild Mercurous Chloride, 64 grains (4.), in Lime Water, 
16 fluidounces (473 Cc). 
Plumbi et Opii (Lead-and-Opium Wash). — Lead Acetate, 
120 grains (8.); Tincture of Opium, \ fluidounce (15 Cc); 
in Water, 16 fluidounces (473 Cc). To be shaken when 
dispensed. 
The following are unofficial solutions and mixtures for external 
use: 

Injectio, -ones. — Aqueous solutions for introduction by means 
of a syringe in the orifices of the body. 



PREPARATIONS FOR EXTERNAL USE. 129 

Injectio Hypodermica. — Solution for hypodermic or subcu- 
taneous injection. 

Enema, -atis ; Clyster. — A warm solution of Soap or a muci- 
laginous mixture for injection in the rectum to produce 
evacuation, or for nutrition. 

Gargarisma, -atis ; Gargle. — A wash or lotion for the throat. 

Collyrium, -i ; "Eye-wash!' — A weak solution for instillation 
in the eyes. 

Nebula, -<z ; Spray. — A liquid intended for application by 
means of an atomizer. 

Vapor, -oris ; Inhalation. — Volatile agents to be added to 
boiling water and inhaled, to affect the air-passages. 

Balneum, -ei ; Bath. — Mixture to be added to water for bath- 
ing purposes. 

OLEATA— OLEATES. 

The official Oleates are solutions of oleates in Oleic Acid. 
They are distinct from the solid oleates, which are made by double 
decomposition of salts of the metals and alkaline earths and 
sodium oleate, or Soap. (See Soap!) 

The liquid Oleates are intended for endermic medication. They 
are applied by inunction, when the Oleic Acid favors the absorp- 
tion of the medicinal agent, the oleate in solution. When it is not 
desirable to administer remedies by the mouth, the Oleates afford 
an effective form of medication. 

The solid Oleates are either dry powders, well adapted for pro- 
tectees as dusting powders, or soft, pliable masses to be applied in 
the form of ointments or plasters. 

Three are official — two liquid, and one, Zinc Oleate, semi-solid. 
They are made by incorporating the solid with the Oleic Acid, 
contained in a warm mortar, and effecting solution with a gentle 
heat : 

Percentage 
by weight. 

Oleatum Hydrargyri .... yellow mercuric oxide 20. 

Oleatum Veratrinae veratrine 2. 

Oleatum Zinci Oxidi zinc oxide 5- 

Unofficial Oleates of the National Formulary. 

The following are simply solutions of the alkaloids in Oleic 
Acid: 
9 



130 A TEXT-BOOK OF MATERIA MEDICA. 

Oleatum — 

Aconitunle. — Contains 2 per cent, of crystallized Aconitine 

(Duquesnel's). 
Quinine. — Contains 25 per cent, of Quinine (Alkaloid). 

Of the solid Oleates introduced by Dr. J. V. Shoemaker, the 
following have been recognized, but others may also be prepared 
as desired : 

Oleatum Plumbi. — Contains about 28 per cent, of Lead Oxide. 

It is of the consistence and general character of Lead Plaster, 

and suggests similar use. 
Oleatum Zinci. — In the form of a soft white powder, useful as 

a " dusting powder," or converted into a plaster or ointment 

by mixing it with such proportion of Oleic Acid as may be 

required. 

OLE A IN FUS A— INFUSED OILS. 

These preparations are obtained by infusing a dry herb, usually 
from the so-called narcotic plants, in five times its weight of a 
mixture of equal parts of Cotton Seed Oil and Lard Oil. Oleum 
Hyoscyami Infusum is the most familiar example. 

Oleum — 

Carbolatum. — A mixture of Cotton Seed Oil with 5 per cent, 
of Carbolic Acid. 

Hyoscyami Compositum (Balsamum Tranquillans). — Infused 
Oil of Hyoscyamus, with a small proportion of each of the 
Ethereal Oils of Absinth, Lavender, Rose, Sage, and Thyme. 

COLLODIA— collodions. 

The Collodions are solutions in Ether-Alcohol of Pyroxylin or 
Soluble Gun Cotton. Upon evaporation of the solvent the remain- 
ing film excludes the air, thus protecting abraded surfaces. Col- 
lodion is also used as a vehicle when a prolonged local effect is 
desired. 

The following forms are official : 

Collodium . . solution in ether 75 ; alco. 25 ; pyroxylin 3 

Collodium Flexile . . . castor oil 3 ; Canada turpentine 5 

Collodium Acidi Tannici . . alco. 5 ; ether 25 ; acid tan. 20 
Collodium Cantharidatum (Blistering Collodion) . (flex. 

collo.) cantharides 60 



PREPARATIONS FOR EXTERNAL USE. 131 

Unofficial Collodions. 
Collodium — 

Iodatum (Iodized Collodion). — Contains 5 per cent. Iodine in 

Flexible Collodion. 
Iodoformatum (Iodoform Collodion). — Contains 5 per cent. 

Iodoform in Flexible Collodion. 
Salicylatum Compositum (Corn Collodion). — Contains 1 1 per 

cent. Salicylic Acid and 2 per cent. Ext. Cannabis Indica in 

Flexible Collodion. 
Tiglii (Croton Oil Collodion). — Contains 10 per cent. Croton 

Oil in Flexible Collodion. 

UNGUENTA— OINTMENTS. 

Ointments are mixtures of a fatty vehicle with which medicinal 
agents are incorporated, readily fusing at the body-temperature, 
35 to40° C. (95 to 104 F.). 

The vehicles used are : Benzoated Lard, Ointment (simple), Lard, 
and Wax or Spermaceti in different proportions, Lard Oil, Olive 
Oil, and Suet. Petrolatum and Wool-fat (Adeps Lance Hydrosus, 
U. S. P.) are employed in unofficial ointments. 

The medicinal ingredients must be minutely distributed through 
the vehicle in order that the ointment may not prove irritating, and 
that the greatest possible surface be presented to the epidermis 
with a view to quick and uniform absorption. For this reason the 
highest quality of an ointment (next to its proper melting-point) is 
smoothness. In the preparation of ointments care must therefore 
be taken that the method employed be such as to yield smooth 
products. 

The melting-point is governed by the fusibility of the vehicle 
used, which is either officially directed, as in official preparations, 
or in extemporaneous preparations prescribed by the physician. 

The twenty-three official Ointments are prepared (1) by me- 
chanical admixture, (2) by fusion, or (3) by chemical reaction. 

Mixing the medicinal substances with the fatty body in a mor- 
tar or on a slab is the process usually employed for solid sub- 
stances, especially when insoluble in the fat. Powdered drugs, 
acids, alkaloids, extracts, and salts (not attended by chemical 
union) are examples adapted to this process. 

The following points must be observed : 

Solids must be in a fine powder before being incorporated with 
the vehicle ; sometimes it is an advantage to triturate the solid with 



132 A TEXT-BOOK OF MA TERIA MEDICA. 

a small quantity of a bland fixed oil, as Almond Oil or Olive Oil, 
into a smooth cream before it is mixed with the vehicle proper — 
Lard, etc. 

Extracts should be reduced to a semi-liquid condition by tritura- 
tion with a little dilute Alcohol or Water. Substances soluble in 
fats, such as Carbolic Acid, Iodine, and Camphor, may be dis- 
solved directly in the fat by the aid of a gentle heat. 

The following are the official Ointments, with their drug- 
strengths, their respective vehicles being given in parentheses : 

Percentage 
Unguentum — of Drugs. 

Acidi Carbolici (ointment) 5 

Acidi Tannici (benz. lard) 20 

Aquae Rosae (Cold Cream) . . spermaceti 12.5 ; white 

wax, 1 2 ; expressed oil of almond 60 

then incorporate borax 0.5 ; rose water 19 

Belladonnas (dil. alcohol 5) extract . . . (benz. lard) 10 

Chrysarobini (chrysophanic acid) 5 

Diachylon (Hebra's) lead plaster 50 

oil lavender 1 ; olive oil 49 

Gallae (benz. lard) 20 

Hydrargyri (Blue Ointment) ........ mercury 50 

mercuric oleate 2 ; suet 23 ; lard 25 

Hydrargyri Ammoniati (benz. lard) 10 

Hydrargyri Oxidi Flavi (ointment) 10 

Hydrargyri Oxidi Rubri (castor oil 5) . . . 10 

Iodi (potass, iod. 1, water 2 parts) .... (benz. lard) 4 

Iodoformi " 10 

Picis Liquidae . . . yellow wax 12.5 ; lard 37.5 ; tar 50 

Plumbi Carbonatis (benz. lard) 10 

Plumbi Iodidi " 10 

Potassii Iodidi (sod. hypo, sulph. 1 ; water 10) 12 

Stramonii (dil. ale. 5) Extract " 10 

Sulphuris (washed) " 30 

Veratrinae (olive oil 6) 4 

Zinci Oxidi . " 20 



Unofficial Ointments of the National Formulary. 

Unguentum Acidi Gallici (U. S. P. 1880). — Contains 10 per 
cent. Gallic Acid. 



PREPARATIONS FOR EXTERNAL USE. 133 

Unguentum Calamine (Unguentum Zinci Carbonatis Im- 
puri; Turner's Cerate). — Contains 17 per cent. Zinc Car- 
bonate (Imp.). 

Unguentum Camphors (Unguentum Camphoratum). — Con- 
tains 20 per cent. Camphor. 

Unguentum Fuscum (Unguentum Matris ; Mother's Salve). 
— Contains 50 per cent, of Camphorated Brown Plaster 
(N. F.). 

Unguentum Mezerii (U. S. P. 1880). — Represents 25 per 
cent. Mezereum. 

Unguentum Picis Compositum (Tar, Comp.). — Contains Oil 
of Tar, 4 per cent. ; Tincture of Benzoin, 2 per cent. ; and 
Oxide of Zinc, 3 per cent. 

Unguentum Sulphuris Alkalinum (U.S. P. 1880). — Contains 
20 per cent. Sulphur and 10 per cent. Potassium Carbonate. 

Unguentum Sulphuris Compositum (Wilkinson's Ointment; 
Hebra's Itch Ointment). — Precipitated Calcium Carbonate, 
10; Sublimed Sulphur, Oil of Cade, of each, 15; Soft 
Soap and Lard, of each, 30 parts. The Lard is mixed 
with the Soft Soarj and Oil of Cade ; the Sublimated 
Sulphur and Precipitated Calcium Carbonate are then grad- 
ually incorporated. 

CERATA— CERATES. 

Cerates are mixtures of fats similar to the ointments, but of 
firmer consistence, because they contain Wax or Resin (having a 
higher melting-point than Lard) in greater proportion than do oint- 
ments. In the preparation of Cerates the same rules are to be 
observed as noted under Ointments. 

The six official Cerates are prepared by fusion or simple admix- 
ture, and one by extraction and digestion (Ceratum Cantharidis) : 

Percentage 
of Drugs. 

Ceratum (Simple) lard 70 ; white wax 30 

Camphorae . camphor liniment 10; lard 60; white wax 30 

Cantharidis (Blistering Cerate) . . .oil of turpentine 15 

lard, 22; cantharides 32 

yellow wax, resin, each 18 

previously fused, and evaporate to 100 

Cetacei . . . olive oil 55 ; white wax 35 ; spermaceti 10 



134 A TEXT-BOOK OF MATERIA MEDICA. 

Percentage 
of Drugs. 

Plumbi Subacetatis (Goulard's Cerate), camphor cerate 80 

solution lead subacetate 20 

Resinse (Basilicon) . . yellow wax 15 lard 50; resin 35 
in cold weather yellow wax 1 2 ; 

lard 53; resin 35 

In the " Blistering Cerate " the maceration in Turpentine Oil 
and subsequent digestion dissolve the vesicating principle of the 
Cantharides, and the preparation is therefore more active. 

Ceratum Camphors Compositum, N. F. (Camphor Ice). — 
Moulded into small cakes suitable for popular use as an applica- 
tion to excoriated surfaces. It contains very small quantities of 
Benzoic and Carbolic Acids. 

Ceratum Extracti Cantharidis (U. S. P. 1880). — Repre- 
sents 30 per cent. Cantharides. 
Ceratum Sabine (U. S. P. 1880). — Represents 25 per cent 
Sabine. 

SUPPOSITORIA— SUPPOSITORIES. 

Suppositories may be defined as variously shaped masses of 
medicated fat, possessing a consistence ensuring their quick fusion 
when introduced in the orifices of the body. 

The U. S. P. defines Suppositories with reference to their 
weights and shapes, corresponding to their several uses — i. e. for 
introduction in the respective orifices of the body — as follows : 

Rectal, cone-shaped, should weigh 15 grains (1 Gm.). 

Urethral, pencil-shaped, should weigh 15 grains (1 Gm.). 

Vaginal, globular, should weigh about 45 grains (3 Gm.). 

The vehicle is Cacao. Butter {Oleum Theobromatis), which pos- 
sesses the property of melting at the temperature of the human 
body, 35° C. (95 ° F.), and yet remaining firm at ordinary tempera- 
tures. An addition of 10 per cent, of spermaceti has been recom- 
mended to raise the melting-point and thus give more stability to 
suppositories during the heated seasons of the year. 

The U. S. P. gives a general formula for preparing supposi- 
tories ; only one Suppository is official, and this is not made from 
Cacao Butter. 

The methods of preparing suppositories are quite numerous : 
any process may be employed by which the product is obtained 
uniform in size and shape and with the medicinal ingredients thor- 



PREPARATIONS FOR EXTERNAL USE. 135 

oughly incorporated. Moulds are usually employed ; the medici- 
nal ingredients, if solid, are first reduced to powder in a mortar, 
and mixed with a small quantity of the grated Fat ; the remainder 
of the Fat, previously melted and cooled to 35 ° C, is then gradually 
incorporated with this mixture, thoroughly mixed, and, if possible, 
without further heating, poured into the moulds, previously chilled. 

Another process consists in rolling the mass on a slab, cutting 
it as in making pills, and forming the cones with the fingers. By 
cold compression in a screw-press " machine," suppositories may 
be formed from the prepared mass. 

Urethral Suppositories are commonly called Bougies, or, more 
properly, Medicated Bougies. They are usually made with the 
addition of Wax, or from Glyco-gelatin mass. 

Suppositoria Glycerini. — Made by reaction of Sodium Carbonate 
5 grains (0.3), in Glycerin \\ grains (6 Gm.), with Stearic Acid 
8 grains (0.5), and heating until a solution of sodium stearate or 
soap is formed, which is poured into a mould. Upon cooling, the 
mixture gelatinizes and the suppository is wrapped in tin-foil. 

Uses. — Upon introduction into the rectum the mass melts, and 
the Glycerin, acting upon the feces, produces evacuation. 

Rectal suppositories are usually made twice the official size, or 
30 grains (2 Gm.), 

A formula for suppositories would be : 

Extracti Belladonnas Fol., ale, 0.1 ; 
Acidi Tannici, 1.0; 

Olei Theobromatis, q. s. (20 Gm.). 
Fiant suppositoriae No. x. (2 Gm.). 

Each suppository would contain \ grain (0.0 1) Ext. Belladonna 
and 1^- grains (0.1) Tannic Acid. 

EMPLASTRA— PLASTERS. 

Plasters are mixtures of various fatty or resinous solids of such 
high melting-point as to be friable when cold, but rendered adhesive 
by the warmth of the body. 

The vehicles of plasters are : Lead plaster ; resinous substances, 
made adhesive by admixture with the medicinal ingredients ; and 
simple plasters, such as isinglass. 

The making of plasters does not differ materially from the pro- 
cess employed for ointments and cerates, since they are all prepared 
by melting the various substances and incorporating the medicinal 



136 A TEXT-BOOK OF MATERIA MEDICA. 

substances last. The spreading of plasters, though usually done 
on a large scale, may be easily effected by the pharmacist with 
the use of a plaster iron. 

The thirteen official Plasters may be divided into — (1) Lead 
Plasters ; (2) Pitch and Gum-Resin Plasters, and (3) Isinglass 
Plaster. 

(1) The most important plasters are made from Lead Plaster, 
or Lead Plaster mixed with Resin, the official Resin Plaster. 

Percentage or 
Emplastrum— P arts in /0 °> 

Plumbi (Diachylon) .... olive oil 60; lead oxide 32 

mix, and add to water 10 
Boil the mixture until the reaction has ceased and 
the plaster is of the right consistence, replacing 
water lost by evaporation from time to time. 

Resinse (Adhesive) yellow wax 6 ; resin 14 

lead plaster 80 
Saponis lead plaster 90 ; soap 10 

From these the following are prepared : 

Emplastrum — 

Arnicae resin plaster 67 ; extract arnica root 33 

Belladonnas ext. belladonna leaves 20 

resin plaster, soap plaster, each 40 
Capsici . . . resin plaster, oleoresin capsicum q. s. 

Hydrargyri, lead plaster 70; mercury oleate 1 .2 ; mercury 30 

Containing lead plaster and pitch : 
Emplastrum — 

Ferri (Strengthening) . . . olive oil, 5 ; ferric hydrate 9 

Burgundy pitch 14; lead plaster 72 

Opii . Burgundy pitch 18 ; lead plaster 76; ext. opium 6 

Picis Cantharidatum (Warming) . . . Burgundy pitch 92 

cerate cantharides 8 

(2) Pitch and Gum Resin Plasters : 
Emplastrum — 

Ammoniaci cum Hydrargyro .... oleate mercury 0.8 

mercury 18 

ammoniac 72; dil. acetic acid, lead plaster, to 100 

Picis Burgundicae olive oil 5 ; yellow wax 1 5 

Burgundy pitch 80 



PREPARATIONS FOR EXTERNAL USE. 137 

(3) Isinglass plaster (Emplastrum Ichthyocollae ; Court-plaster). 
— A solution of 10 Gm. Isinglass is dissolved in hot Water 120 
Gm. ; one-half of the solution is spread upon silk (taffeta) in suc- 
cessive layers, and when dry the other half of the solution is spread 
on in a similar manner, after first having been mixed with Alcohol 
40 Gm., Glycerin 1 Gm. The taffeta is then coated on the reversed 
side with Tincture of Benzoin to make it waterproof and antiseptic. 

Unofficial Plasters of the National Formulary. 
Emplastrum — 

Ammoniaci (U. S. P. 1880). — Gum-resin Ammoniac with 
Acetic Acid. 

Aromaticum (Spice Plaster). — Consisting of Cloves, Cinna- 
mon, and Ginger, each, 10 per cent; Capsicum and Cam- 
phor, each, 5 per cent. 

Asafcetim: (U. S. P. 1880). — Asafcetida 35 p.; Galbanum 15 
p. ; with Lead Plaster. 

Fuscum Camphoratum (Matris Camphoratum, Ph. Ger.). — 
Camphorated Mother's Plaster. A plaster similar to lead 
plaster, and containing camphor, 1 per cent. 

Galbani (U. S. P. 1880). — Galbanum Plaster. 

Picis Canadensis (U. S. P. 1880). — Canada Pitch Plaster. 

Picis Liquids Comp. — A mixture of Resin and Tar, with Podo- 
phyllum, Phytolacca, and Sanguinaria, of each, 10 per cent. 

CHARTS— rAPERS. 

There are two Papers official. One is made by saturating strips 
of white unsized paper in a 20 per cent, solution of Potassium 
Nitrate and drying; the other is paper coated with Mustard, used 
similarly to the Plasters : 

Charta Potassii Nitratis .... potass, nitrate 20 ; water 80. 

Vapors from incineration as inhalant. 
Charta Sinapis . . oil-free black mustard, 4 Gm. in 60 sq. cm. 
The Mustard is freed from the fixed oil by extraction with Ben- 
zin, and mixed with a solution of India Rubber in equal volumes 
of Benzin and Carbon Disulphide, and spread upon Paper. This 
is the well-known Mustard Plaster or Mustard Paper. When 
applied, the paper should be immersed in lukewarm water for a 
few minutes, in order to render the vesicating principle active. 
Charta Cantharidis, U. S. P. 1880. — Cantharidis Paper (Blis- 
tering Paper). 



138 A TEXT-BGOK OF MATERIA MEDICA. 

Poultice or Cataplasm (Lat. Cataplasma, -atis). — A coarsely- 
ground substance or mixture of substances, such as flaxseed or 
elm-bark, made into a mass with hot water or some other liquid, 
spread upon cloth or filled into porous bags, and applied to the 
body while hot. 

Fomentations (Lat. Fomentum, -1). — Porous woollen cloths sat- 
urated with hot infusion or decoction of herbs, or other hot liquids 
or lotions, and applied hot. 

Spongiopiline. — A thick cloth covered with layers of sponge 
for the saturation and retention of medicinal agents intended for 
absorption, the exterior being composed of waterproof material, 
such as rubber. 

Plaster-Mull. — A thin cloth made impervious with rubber or 
gutta-percha tissue, upon which is spread or painted medicinal 
agents in the liquid form, intended for local application. 

Caustics or Escharotics (Gr. Escharotikos). — Substances used 
to destroy tissue by chemical action or by heat, either semi- 
solid mixtures made into a paste with starch or other diluent, or 
chemicals fused and moulded into sticks called peiicils or "crayons " 
(Lat. stilus, -1), to be applied directly to the skin. Moxa is the 
name given to small cones of combustible substances which upon 
incineration do not inflame, but give off an intense heat, used for 
cauterization when heat is desired. 

Bandages; Antiseptic Dressings. — The material used for 
bandages is cellulose in various modifications, such as cotton, 
linen, jute, and other fibrous substances. Aside from the me- 
chanical support afforded, bandages also serve to keep wounds 
clean by absorbing and withdrawing secretions (pus) which would 
otherwise prove irritating, and by protecting them against extrane- 
ous matter serve to promote the healing process. 

These various substances may be used either plain or medi- 
cated, when they are called antiseptic. 

Gossypium Purification, U. S. P. ; Absorbent Cotton. — The hairs 
of Gossypium herbaceum L., freed from oil and resinous substances 
by treatment with alkalies and bleaching agents. These hairs rep- 
resent microscopic ducts in which liquids are absorbed through 
capillarity. The freer from oily constituents, the more readily will 
watery liquids be taken up and retained ; hence the absorbability of 
cotton depends upon its purity. This is equally true with all other 
bandage material. 

Linen in the form of thin sheets, known as Muslin or Muslin- 



PREPARATIONS FOR EXTERNAL USE. 139 

gauze, or purified similarly to cotton, when it is called Lint, is 
made from the bast-fibres of the Linum usitatissimum L., Flax. 
Hemp and Jute are the bast-fibres of their respective plants. 

Medicated Dressings. — These are made by saturating the ma- 
terial or vehicle in a solution of certain strength of the medicinal 
agent, or incorporating the latter in powdered form. In the appli- 
cation of a dressing which has been rendered aseptic or antiseptic 
by impregnating it with Phenol (Carbolic Acid), Salicylic Acid, 
Mercuric Chloride, or similar agent, it is desired to bring in con- 
tact with the wound a solution of certain strength — for example, 
a 5 or 10 per cent, solution of Phenol, a ^ or -fa of 1 per cent, 
solution of Mercuric Chloride, etc. The quantity of material which 
conveys the agent is of no consequence, as the fabric simply serves 
as a vehicle for the medicinal or antiseptic agent. The strengths 
of such dressings should therefore be designated by the percentage- 
strength of the solutions by which they are saturated, rather than by 
the percentage by weight of the medicinal agent the finished dress- 
ing may contain. 

In dressings of antiseptic agents that are usually applied in sub- 
stance, such as Boric Acid and Iodoform, the percentage-amount 
actually contained by weight in the finished dressing should be 
stated. Here the use of a vehicle is only a matter of convenience, 
and it is desirable to know just how much of the medicinal agent 
is contained in a certain quantity by weight or by area of the 
dressing. 

Medicated Cottons. — Purified cotton is saturated in a solution 
in Water, or Glycerin and Water, of the strength desired of the 
medicinal agent, and thoroughly expressed. 

The following are the usual strengths : 

Percentage. 

Gossypium Boratum acid boric 5 or 10 

Carbolatum phenol 5 or 10 

Iodoformatum iodoform 10 to 20 

Salicy latum acid salicylic 10 to 20 

Stypticum Monsel's solution 

Sublimatum mercuric chloride y 1 ^ to T V 

Iodoform, being insoluble in Water, should be dissolved in Ether 
or, preferably, in a mixture of Alcohol and Glycerin. 

Medicated Gauzes ; Carbasa. — The material used for making 
Medicated Gauzes is a muslin gauze free from sizing or other ex- 
traneous matter. The gauze is thoroughly impregnated with the 



140 A TEXT-BOOK OF MA TERIA MEDICA. 

solution of the particular strength required, then forcibly expressed, 
after which it is ready for use ; or, if desired for future use, it should 
be tightly rolled, wrapped in parchment paper, and kept in closely 
covered boxes in a cool, dry place. 

The following are the most commonly used Gauzes and their 
strengths : 

Percentage. 

Carbasus Boratum acid boric 5-10 

Carbolatum phenol 5-10 

Iodoformatum . iodoform 10-20 

Salicylatum acid salicylic 10-20 

Sublimatum mercuric chloride ^ ^ 

The Iodoform Gauze is made in the same way as the Cotton, 
by saturation with a solution of Iodoform in Alcohol and Glycerin. 
All the others, except the Mercurial Gauze, contain Glycerin. 
Mercuric Chloride is dissolved in Water with a little Acid Tartaric 
(5 parts for 1 of Mercuric Chloride), the presence of which in the 
Gauze prevents the formation of insoluble albuminate of mercury 
when it is brought in contact with the albuminous discharges from 
wounds. 

Plaster-of-Paris bandages are made by thoroughly incorpo- 
rating Calcium Sulphate (gypsum) into linen bandages. When 
applied, the bandage, after being dipped in water, sets hard and 
firm in a few minutes. 



CLASS I.-DISEASE MEDICINES 



DIVISION I.— RESTORATIVES. 



GROUP I.— DIGESTANTS. 

[In the present work care has been taken to designate the proper pronunciation 
[Foster) of the names of drugs and their preparations common to Materia Medica and 
Therapeutics. The simplest and most efficient method appears to be that herein fol- 
lowed — namely, to indicate accent and quantity by a single sign ; for example, Pep- 
slnum (nom.) — Pepslni (gen.), in which the i is long and the accent upon the second 
syllable; Cocculus — Cocculi, in which the o is short and the accent upon the first 
syllable. 

In nearly all cases the genitive, as used in prescription-writing, and the English 
equivalent, are given. When the accusative, not genitive, is adopted, the usage is 
marked by "(ace.)"; as Piluke, Pllulas (ace), etc.] 

PepsTnum— Pepslni— Pepsin. U. S. P. 

Origin. — A proteolytic ferment or enzyme obtained from the 
glandular layer of fresh stomachs from healthy pigs, and capable 
of digesting not less than 3000 times its own weight of freshly 
coagulated and disintegrated egg albumen when tested by the 
process given in the United States Pharmacopoeia. 

Description and Properties. — A fine white, or yellowish-white, 
amorphous powder, or thin, pale yellow, or yellowish, transparent 
or translucent grains or scales, free from offensive odor, and having 
a mildly acidulous or slightly saline taste, usually followed by a 
suggestion of bitterness. It slowly attracts moisture when exposed 
to the air. Soluble, or for the most part soluble, in about 100 parts 
of water, with more or less opalescence ; more soluble in water acid- 
ulated with hydrochloric acid ; insoluble in alcohol, ether, or chlo- 
roform. Pepsin usually has a slightly acid reaction. It may be 
neutral, but should never be alkaline. 

Dose. — 5-60 gr. (0.3-4.0 Gm.). 

141 



142 A TEXT-BOOK OF MA TERIA MEDICA. 

Official Preparations. 

Pepsinum Saccharatum — Pepsini Saccharati — Saccharated Pepsin. 

Formula: Pepsin 10, Sugar of Milk 90 parts. Dose, 30 gr-4 dr. (2.0-16.0 Gm.). 

Antagonists and Incompatibles. — Tannic and gallic acids are 
incompatibles. Mineral salts, alcohol, and alkalies precipitate pep- 
sin from solution, the two latter impairing its digestive property. 
The " Wine of Pepsin " is therefore unreliable. 

Synergists. — Diluted hydrochloric acid, in not over -^ of 1 
per cent, increases its digestive action. 

Physiological Action. — Its only influence seems to be upon the 
digestive system. Pepsin is a typical restorative, being a normal 
constituent of the gastric juice, and in the presence of hydrochloric 
acid digesting the proteid elements of the food, converting them 
into albumoses, and finally into peptones. 

Therapeutics. — Externally and Locally. — Its digestive action is 
utilized to dissolve or digest the false membrane in diphtheria and 
croup. A solution of pepsin has also been injected into the blad- 
der to digest blood-clots. 

Internally. — As a restorative, where there is a lessened secre- 
tion of gastric juice, atonic dyspepsia, apepsia of infants, cancer of 
the stomach, and gastric ulcer, pepsin has proved serviceable. It is 
also employed to favor digestion in convalescence from acute and 
long illness. It is frequently necessary to give pepsin, or " pepton- 
ized milk/' in acute dyspeptic diarrhea of infants. 

Administration. — Pepsin should be given in powder or dis- 
solved in glycerin (Glycerol of Pepsin), or in water acidulated with 
hydrochloric acid, directly after meals. 

The drug should not be given continuously for too long a 
period, lest the function of the stomach become impaired from 
disuse, the artificial digestion having replaced the natural, normal 
process. 

Unless there be some direct indication for its use, rather than 
give pepsin it is better to stimulate the gastric glands to secrete a 
larger amount of their normal juice, that they may not lie idle, 
and their function be consequently impaired by disuse. Hydro- 
chloric acid administered with pepsin probably slightly promotes 
glandular activity. Often, however, pepsin must be given, and in 
certain cases the stomach is in such a condition that nutrient en- 
emata must be administered. Yet, since the rectum possesses very 
feeble powers of digestion, foods should always be predigested. Sup- 
positories of peptonized meat are frequently used for this purpose. 



DIGESTANTS. 143 

Pancreatlnum— Pancreatlni— Pancreatin. V. S. JP. 

Origin. — A mixture of the enzymes naturally existing in the 
pancreas of warm-blooded animals, usually obtained from the fresh 
pancreas of the hog. 

Description and Properties. — A yellowish, yellowish-white, or 
grayish amorphous powder, odorless, or having a faint, peculiar, 
not unpleasant odor, and a somewhat meat-like taste. Slowly and 
almost completely soluble in water, insoluble in alcohol. 

Pancreatin digests albuminoids and all proteid substances, con- 
verts starch into sugar, and, when not over twenty-four hours old, 
aids in the digestion of fats. Prolonged contact with mineral acids 
renders it inert. 

Dose. — 10-20 gr. (0.6-1.2 Gm.). 

Antagonists and Incompatibles. — Strong mineral acids. 

Synergists. — Weak alkalies. 

Physiological Action. — The four ferments which it contains 
render it capable, in either weak alkaline or acid media, of digest- 
ing proteid foods ; emulsifying fats and oils, and resolving them 
into fatty acids and glycerin ; converting starch into sugar ; and 
curdling milk. 

Therapeutics.— Like pepsin, it is used as an artificial agent in 
certain disorders of digestion. 

Administration. — It may be given dry, in powder, capsules, or 
compressed pills, or in solution. It should be administered in 
combination with an alkali, as the activity of pancreatin is de- 
stroyed by acids, and should be given ordinarily from two to four 
hours after meals, when the chyme has entered the intestine. It 
may also be administered immediately after eating or with the food, 
since there is an interval of from fifteen minutes to half an hour 
after the ingestion of food before the stomach-contents are ren- 
dered sufficiently acid by the gastric juice to interfere with the 
activity of the pancreatin. 

For rectal nourishment pancreatin is preferable to pepsin, be- 
cause of its superior action in predigesting food. 

Papain, Papoid, or Papayotin. 

Origin. — The inspissated juice of the unripe fruit of Carica 
Papaya. 

Description and Properties. — A whitish, slightly astringent 
powder, soluble in water. 

Dose. — 1-8 gr. (0.06-0.5 Gm.). 



144 A TEXT-BOOK OF MATERIA MEDICA. 

Antagonists and Incompatibles. — Tannic and gallic acids. 
Lead salts and alcohol are incompatible with papain. 

Synergists. — The digestive ferments. 

Physiological Action. — In this it resembles pepsin, though dif- 
fering from the latter, as well as from pancreatin, in that it is 
equally active in neutral, alkaline, or acid media. It converts pro- 
teids into soluble peptones, and acts as a stimulant to the gastric 
glands. It converts starch into maltose, and upon false membranes 
acts more energetically than pepsin. It may dissolve intestinal 
worms. 

Therapeutics. — Externally. — The uses of papain are more mani- 
fold than those of the digestive ferments previously mentioned. 
Like pepsin, it has been successfully employed to dissolve false 
membrane in diphtheria and croup. The juice of pineapple, which 
possesses a ferment (bromelin) similar to that of papain, is a val- 
uable domestic remedy in these diseases. Papain has been used 
with some benefit in indurated eczema and in syphilitic ulcerations 
of the tongue. It has been highly recommended by Johnston as a 
solvent of cerumen: 15 drops (1.0 Cc.) of a solution of 20 grains 
to 1 oz. (1.2 Gm-30 Cc.) of distilled water are dropped into the 
outer meatus, and the parts syringed an hour afterward with a 
solution of boric acid. 

Internally, papain may be used for the same purposes as pepsin 
and pancreatin ; yet, while theoretically superior, it is practically 
inferior to them, fortunately not having supplanted them in actual 
practice. 

Administration. — When used to aid digestion, papain should be 
given after meals, either in powders, capsules, compressed tablets, 
or aqueous solution freshly prepared. 

Diastase.— Amylolytic Enzymes. 

In the germination of many seeds the starches contained therein 
are converted by enzymes into soluble starch or sugars, and thus 
nourish the young plant. Many bacteria are capable of breaking 
down starches, as well as proteids, and some moulds develop 
amylolytic as well as proteolytic enzymes of marked activity. 

Of late years much use has been made of a number of these 
enzymes. That from grain — barley, malt — containing the enzyme 
diastase has been widely used, especially in proprietary medicines. 

Diastase prepared from malt that has not been heated above 
1 35 F. is capable, in neutral or very slightly acid or alkaline solu- 



DIGESTANTS. 145 

tions, of digesting appreciable quantities of starch. It is doubtful, 
however, if this action will take place in the stomach to any appre- 
ciable extent, and still more doubtful if, in the treatment of what 
has been termed starchy indigestion — amylaceous dyspepsia — such 
malt compounds are of any service. The clinical evidence adduced 
to the efficiency of such compounds should be taken with caution. 

One amylolytic ferment from a mould, the Aspergillus oryzae 
(Ahlburg), which has been utilized in the breweries of Japan for 
centuries, particularly in the production of the Japanese rice wine 
(Sake), has been introduced within recent years into pharmaco- 
therapeutics under the name of taka-diastase. It is very active, but 
it is quite doubtful if it has any particular action on the undigested 
starch found in the intestines after it has been in the stomach for 
any length of time. Excellent clinical observers report good 
results, and it is deserving of trial. In all questions concerning 
the action of foreign ferments it should be remembered that they 
are largely foreign proteid bodies and are probably broken up and 
digested as such, apart from their action as enzymes, by the natural 
enzymes of the digestive tract, notably by pepsin. 

Of the many malt preparations on the market, the best that 
critical science can say of them is that they are excessively high- 
priced foods. Some of them have been deliberate frauds. 



GROUP II.— FATS AND OILS. 

Oleum Morrhuae— Olei Morrhuae— Cod Liver Oil. 

U. S. P. 

Origin. — A fixed oil obtained from the fresh livers of Gadits 
Morrhua L. and other species of Gadus. 

Description and Properties. — A pale-yellow, thin, oily liquid, 
having a peculiar, slightly fishy, but not rancid odor, and a bland, 
slightly fishy taste. Specific gravity 0.920 to 0.925 at 15 C. 
(59 F.). Scarcely soluble in alcohol, but readily soluble in ether, 
chloroform, or carbon disulphide, also in 2.5 parts of acetic ether. 
It contains glycerides of stearin and palmitin, traces of iodine, 
bromine, chlorine, biliary salts, phosphoric and sulphuric acids, and 
several alkaloids (leucomains), possibly decomposition-products. 
The most important of these, isolated by Gautier, are butylamine. 
hexylamine, amylamine, asseline, and morrhuine. It is doubtful if 
any one active principle exists in this oil. 

70 



146 A TEXT-BOOK OF MATERIA MEDIC A. 

Morrhuol, a name given by Chapoteaut to a mixture of the 
various alkaloids and important principles of cod-liver oil, occurs 
as an amber-brown, bitter, aromatic liquid. 

Dose. — 1-4 fluidrachms (3.8-15 Cc). 

Physiological Action. — Externally and Locally. — It possesses 
emollient properties, and may be applied to the skin and mucous 
membranes without causing irritation. It slightly reduces tempera- 
ture in fever when applied to the body. 

Internally. — Fat is a normal and necessary constituent of the 
body. It is the fuel used to supply energy, and those tissues and 
organs which are the most active require the most fat. Conse- 
quently, nerves, muscles, and glands are more abundantly fur- 
nished with fat than cartilage, and in cases of starvation those 
structures demanding the greater supply must have it, at the ex- 
pense of the less highly organized and active tissues — as is seen in 
the great emaciation preceding the decline of mental powers. The 
blood contains about one-half of 1 per cent, of fat ; the muscles, 3 
per cent. ; the brain, 8 per cent. ; and the nerves 22 per cent. In 
order, therefore, that the various cells of the body may possess 
sufficient vitality to withstand by physiological resistance the en- 
croachments of disease and the invasion of pathogenic micro-or- 
ganisms, this equilibrium must be maintained. Yet this necessary 
food, fat, is more frequently deficient than any other, from the 
difficulty either of obtaining a supply or of digesting and assimi- 
lating it. 

Dr. Hughes Bennett was near the truth in observing that " the 
main causes of tuberculosis are the dearness of butter and the 
abundance of pastry-cooks," intimating that the poor and underfed 
are unable to obtain sufficient fat, while the digestion of the 
wealthy class is deranged by pastries, so that they are unable to 
assimilate a proper amount of fat. 

Before oils or fats can enter the various cells and act as food, 
and consequently a source of power, they must be digested and 
assimilated by the system. The value of an oil is based upon — (1) 
Its rate of absorption ; (2) its rate of oxidation ; (3) its agreeable 
taste. 

Cod liver oil, while to many persons repugnant in taste, is more 
readily absorbed and oxidized than any other fat. It has already 
been prepared by the liver, and therefore partly elaborated, and, 
owing to the biliary salts which it contains, it passes more readily 
through animal membranes. Moreover, Naumann has shown that 



FATS AND OILS. 147 

cod liver oil is more easily oxidized than any other oil, rendering 
this substance almost an ideal ready-made food. Its actions upon 
the several systems are here considered. 

Digestive System. — Large doses disturb the stomach and may 
even occasion vomiting, but in medicinal doses alone, or in the 
form of an emulsion, it may be taken usually without discomfort, 
in some cases even increasing the appetite. In the stomach cod- 
liver oil is unaffected, but in the intestines it meets the pancreatic 
juice, which resolves a portion of it into glycerin and fatty acids, 
the latter combining with the alkalies of the bile and the intes- 
tinal juice to form soaps, while the remaining, and larger, por- 
tion is emulsionized by the alkaline secretions of the intestines. 

Circulatory System. — The number of red corpuscles is increased 
and the quality of the blood is greatly improved. 

Nervous System. — This shares with the other tissues of the body 
the general amelioration, the drug being a food and tonic to the 
brain and nerves. 

Respiratory System. — No special action is noticeable other than 
the natural improvement in the respiratory power incidental to 
better blood and an increased functional activity of the nerves and 
muscles. 

Absorption and Elimination. — Cod liver oil can be absorbed only 
after it enters the intestines. The glycerin and fatty acids formed 
by the pancreatic juice are readily absorbed by the mucous mem- 
brane, together with the soaps produced by the action of the bile 
and the intestinal juice. 

The oil remaining, as has been stated, is emulsionized — that is, 
it is subdivided into minute globules each enclosed in an envelope 
composed of alkaline albuminate and soap, which has a great 
affinity for the mucous membrane and carries the oil through the 
columnar epithelium of the intestinal villi into the lymph-spaces. 
The osmosis inward of the oil-emulsion is rendered still easier by 
the action of the bile with which the mucous membrane is 
bathed. 

It will be seen that much of the oil taken into the system is 
oxidized, being subsequently excreted as carbonic acid and water. 

Temperature. — When taken internally the temperature is unaf- 
fected, but, as has been observed, when applied to the epidermis 
the bodily heat is reduced. 

Untoward Action. — In addition to disturbances of digestion 
sometimes occasioned by moderate doses, cod liver oil at times 



148 A TEXT-BOOK OF MATERIA MEDIC A. 

produces a vesicular eczema which may spread over the entire 
body. This eruption is probably caused by the volatile fatty acids 
which the oil contains. At times it may cause a diarrhea. 

Poisoning. — Cod liver oil possesses no poisonous action. 

Therapeutics. — Externally and Locally. — Cod liver oil is much 
used by dermatologists in diseases of the skin, being especially ser- 
viceable in softening the crusts of eczema. It has been applied to 
the skin to allay irritation and for the reduction of temperature in 
the exanthemata. In cases of marasmus and rachitis, and in wasting 
diseases generally, it is a valuable remedy to sustain the vital 
energy and improve nutrition, the oil being given in the form of 
baths. 

Daily inunctions are beneficial in chronic scaly skin diseases, 
while a local application to the chest has seemed at times to influ- 
ence favorably the course of pertussis. 

Internally. — For two or three centuries cod liver oil has been 
used both externally and internally for chronic rheumatism, but it 
is only since 1841 that it has been employed in the treatment of 
ttiberculosis. While to-day it does not receive the enthusiastic 
support which attended its introduction in the latter disease, it is 
nevertheless a standard and highly efficacious remedy in the various 
forms of the disorder. It is equally valuable in scrofulous affections, 
and even more potent in rachitis. Chronic bronchitis is perhaps 
more frequently relieved by its use than by any other internal 
remedy. Diseases resulting in anemia are usually more benefited 
by cod liver oil than by other remedial agents. CJironic arthritis, 
fistula, and abscess in the neighborhood of the joints have been 
greatly improved by its use. Atheroma of the arteries and many 
cutaneous diseases, particularly the strumous variety, and syphilo- 
dermata yield to its alterative and nutrient properties. 

Probably no single drug is employed in nervous diseases with 
effects so markedly beneficial as those of cod liver oil. While 
possessing no specific action, it increases the strength and vitality 
of the patient, enabling him to resist morbid tendencies more suc- 
cessfully, and, by augmenting the force-producing material and 
improving the condition of the nerves, lessens the liability to 
nervous derangement. 

Diabetes mellitus and Bright 's disease, with anemia yet unat- 
tended by marked digestive disturbance, are decidedly improved 
by the administration of cod liver oil. 

Should no gastric disorder supervene, this remedy should invari- 



FATS AND OILS. 149 

ably be given in the last-named diseases. It certainly serves to 
maintain the general health, and is singularly efficacious in pro- 
longing the lives of the afflicted patients, enabling them to profit 
by hygienic measures, upon which great reliance should be placed. 
The tonic and nutritive properties of the drug have been strikingly 
shown in the rapid improvement of patients convalescing from 
acute diseases. In catarrhal conditions, especially in ozena and otitis 
following measles and scarlet fever, it is of marked benefit. 

Without entering upon specific considerations other than the 
above, it will be seen that cod liver oil is indicated whenever there 
is defective activity, whether inherited or acquired. 

Contraindications. — It is to be remembered that cod liver oil 
is a food and not a medicine : it is therefore contraindicated in all 
diseases where it proves detrimental to the appetite, causing eruc- 
tation, heartburn, diarrhea, etc. It is usually contraindicated in 
fevers, owing to the suspension of the secretions and impairment 
of digestion characteristic of acute febrile disorders. 

Administration. — In the early use of cod liver oil it is advis- 
able to prescribe small doses, that its toleration by the stomach 
may be gradually acquired. To many patients, however, it is ex- 
tremely distasteful, and the repugnance is increased rather than 
lessened by continued use. In such cases it is better, if possible, 
to disguise the taste and smell in some manner rather than to 
abandon so valuable a remedy when clearly indicated. Various 
means have been employed for this purpose. An emulsion may 
be made which obviates its disagreeable qualities. There are in 
the market soft capsules containing this oil that serve an excellent 
purpose, being easily swallowed and disguising completely the 
taste and odor of the drug. Administration should occur ordi- 
narily some time after meals, that the oil may reach the intestines 
as soon as possible. 



GROUP III.— MINERAL ACIDS. 

Mineral Acids are classed here as Restorative Medicines, be- 
cause some of them appear in the normal secretion from certain 
glands, as, for instance, the gastric glands and in the perspira- 
tion' and urine. Sulphuric and nitric acids are not normal 
constituents of the body, and are by some authors classed as 
escharotics, although the action and medical uses of these inor- 
ganic acids will here be considered. There are, however, certain 



150 A TEXT-BOOK OF MATERIA MEDICA. 

characteristics common to all mineral acids which claim primary 
attention : 

i. Concentrated mineral acids are caustic to a greater or less 
degree. 

2. They combine with alkalies and alkaline earths to form salts, 
and unite with vegetable acids, setting them free from their com- 
bination with bases. 

3. When in contact with the tissues of the body they combine 
with the protoplasm, neutralizing the alkalies which the latter con- 
tains and forming mineral salts. They also combine with the albu- 
min, forming acid albumin. 

4. Upon the blood they precipitate the albuminous constituents 
and decompose the hemoglobin. 

5. Acids are said to stimulate the secretion from alkaline 
glands. On the other hand, they depress the secretion from 
acid glands. 

6. They diminish the functional activity of the muscular and 
nervous systems. Applied locally in a concentrated form, or taken 
internally in poisonous doses, they tend to produce rigidity of the 
muscles by coagulating the myosin (Brunton). 

7. The alkalinity of the blood is lessened and the acidity of 
the urine increased by the internal administration of all mineral 
acids. 

Acidum Hydrochloricum— Acidi Hydrochloric!— 
Hydrochloric Acid. IT. S. P. 

(Muriatic Acid.) 

Origin. — A liquid composed of 3 1.9 per cent, by weight of Abso- 
lute Hydrochloric Acid (HCL=36.37) and 68.1 per cent, of Water. 

Description and Properties. — A colorless, fuming liquid, of a 
pungent odor and an intensely acid taste. Fumes and odor disap- 
pear on diluting the acid with 2 volumes of water. Specific grav- 
ity about 1. 1 63 at 1 5 C. (59 F.). Miscible in all proportions with 
water and alcohol. Hydrochloric acid should be kept in dark, 
amber-colored, glass-stoppered bottles. 

Dose. — 2-5 minims (0.12-0.3 Cc), well diluted. 

Official Preparations. 

Acidum Hydrochloricum Dilutum— Acidi Hydrochlorici Diluti— Diluted 
Hydrochloric Acid (Diluted Muriatic Acid).— Dose, 10-20 minins (0.6-1.2 Cc). 
Formula: Hydrochloric Acid, ioo; Distilled Water, 219. Sp. gr. about I.050. 

Acidum Nitrohydrochloricum -Acidi Nitrohydrochlorici— Nitrohydro- 



MINERAL ACIDS. 151 

chloric Acid. — Dose, 2-5 minims (0.12-0.3 Cc), well diluted. (Described under 
Nitric Acid.) 

Acidum Nitrohydrochloricum Dilutum — Acidi Nitrohydrochlorici Diluti 
— Diluted Nitrohydrochloric Acid. — Dose, 5-20 minims (0.3-1.2 Cc). (Described 
under Nitric Acid.) 

Acidum Phosphoricum— Acidi Phosphorici— 
Phosphoric Acid. U. S. JP. 

Origin. — A liquid composed of not less than 85 per cent, by- 
weight of Absolute Orthophosphoric Acid (H 3 P0 4 = 97.8) and not 
more than 15 per cent, of Water. 

Description and Properties. — A colorless liquid, without odor, 
but having a strongly acid taste. Specific gravity not below 1.7 10 
at 1 5 C. (59 F.). Miscible in all proportions with water or alco- 
hol. Phosphoric acid should be kept in glass-stoppered bottles. 

Dose. — The diluted acid only is given internally. 

Official Preparation. 

Acidum Phosph8ricum Dilutum — Acidi Phosph5rici Diluti (Diluted Phos- 
phoric Acid). — Dose, 5-25 minims (0.3-1.5 Cc). Diluted phosphoric acid contains 
10 per cent, by weight of absolute orthophosphoric acid. 

Acidum Sulphuricum— Acidi Sulphurici— Sulphuric 

Acid. U. S. JP. 

Origin. — A liquid composed of not less than 92.5 per cent, by 
weight of Absolute Sulphuric Acid (H 2 S0 4 = 97.82) and not more 
than 7.5 per cent, of Water. 

Description and Properties. — A colorless liquid of oily con- 
sistence, inodorous, and very caustic and corrosive. Specific gravity 
not below 1.835 at I 5° C. (59° F.). Miscible in all proportions 
with water and alcohol, with evolution of so much heat that the 
mixing requires great caution. Sulphuric acid should be kept in 
glass-stoppered bottles. 

Dose. — 2-5 minims (0.12-0.3 Cc), well diluted. 

Official Preparations. 

Acidum Sulphuricum Arom^ticum — Acidi Sulphurici Arom&tici — Aro- 
matic Sulphuric Acid. — Dose, 5-20 minims (0.3-1.2 Cc). Formula: Sulphuric 
Acid, 100; Tincture of Ginger, 50; Oil of Cinnamon, I ; Alcohol, to make 1000 parts. 

Acidum Sulphuricum Dilutum — Acidi Sulphurici Diluti — Diluted Sul- 
phuric Acid. — Dose, 5-20 minims (0.3-1.2 Cc). Diluted sulphuric acid contains 
10 per cent, by weight of absolute sulphuric, acid. 



15^ A TEXT-BOOK OF MATERIA MEDIC A. 

Acidum NItricum— Acidi NTtrici— Nitric Acid. 

77. S. JP. 

Origin. — A liquid composed of 68 per cent, by weight of Abso- 
lute Nitric Acid (HN0 3 = 62.89) and 3 2 P er cent - °f Water. 

Description and Properties. — A colorless, fuming liquid, very 
caustic and corrosive, and having a peculiar, somewhat suffocating 
odor. Specific gravity about 1.414 at 15 C. (59 F.). Nitric acid 
should be kept in dark, amber-colored, glass-stoppered bottles. 

Dose. — 2-5 minims (0.12-0.3 Cc), well diluted. 

Official Preparations. 

Acidum NItricum Dilutum — Acidi Nitrici Diluti — Diluted Nitric Acid. — 

Dose, 5-20 minims (0.3-1.2 Cc). Diluted nitric acid contains 10 per cent, by weight 
of absolute nitric acid. 

. Acidum NitrohydrochlSricum — Acidi Nitrohydrochlorici — Nitrohydro- 
chloric Acid. — Formula: Nitric Acid, 180; Hydrochloric Acid, 820 parts. 

Description and Properties.— A golden yellow, fuming, and very corrosive liquid, 
having a strong odor of chlorine. Completely volatilized by heat. It readily dissolves 
gold-leaf, and a drop of it added to potassium iodide T. S. liberates iodine. 

Dose. — 1-3 minims (0.06-0.18 Cc). 

Acidum Nitrohydrochloricum Dilutum — Acidi Nitrohydrochlorici Diluti — 
Diluted Nitrohydrochloric Acid. — Dose, 5-20 minims (0.3-1.2 Cc). Formula: 
Nitric Acid, 40; Hydrochloric Acid, 180; Distilled Water, 780 parts 



Antagonists and Incompatibles. — Hydrochloric acid and its 
preparations are incompatible (forming explosive compounds) with 
oxidizable substances — phosphorus, sulphur and the sulphides, 
alcohols, ethers, carbohydrates, etc. All the mineral acids are in- 
compatible with the alkalies and their carbonates, salts of lime, 
lead, and silver, and decompose glucosides. 

Synergists. — The action of hydrochloric acid upon the diges- 
tive system is aided by the digestive ferments and the vegetable 
bitters. 

Physiological Action. — The general action of mineral acids 
upon the various systems is herewith given in detail : 

Externally and Locally. — Applied in a concentrated form to the 
skin or to any tissue of the body, acids abstract the water from 
the tissues and destroy the protoplasm, acting as escharotics. 
Weaker solutions vesicate, merely inflaming the parts to which they 
are applied, without destroying the tissue, while extremely diluted 
or weak solutions are irritant and astringent. 

Internally. — Digestive System. — Diluted acids only should be 
administered internally. Save with reference to the poisonous 



MINERAL ACIDS. 153 

effects of concentrated acids, therefore, the physiological action of 
diluted acids only will be here considered. 

The salivary glands are stimulated, resulting in an increased flow 
of saliva, moistening the mouth and allaying thirst. The appetite 
and digestion are improved, and the secretions from the liver and 
the duodenal glands are increased. Long-continued use of the 
mineral acids impairs digestion by lessening the normal secretion 
of the gastric glands, while protracted use may produce salivation 
and a train of symptoms — anemia, loss of flesh, etc. Mineral acids 
tend to constipate the bowels. 

Circulatory System. — Diluted acids in medicinal doses cause a 
rise in blood-pressure, and increased action of the heart, prob- 
ably due to their stimulating action on the vaso-motor mechanism. 
Concentrated acids relax the muscular tissue of both the heart 
and blood-vessels. Mineral acids combine with the albumin or 
the alkaline bases of the blood, lessening the alkalinity of that 
fluid. 

Nervous System. — Medicinal doses, so far as observed, produce 
no special action upon the nervous system other than to occasion 
a slight stimulation of the brain, due probably to a gentle arterial 
excitement. 

Respiratory System. — No important action under medicinal doses 
has been observed. 

Absorption and Elimination. — Mineral acids, above all hydro- 
chloric acid, are readily absorbed. They are quickly converted 
into neutral salts in the intestines, and are absorbed as such. The 
excess of the acid which does not enter into combination in 
the stomach and intestines is rapidly absorbed into the blood, com- 
bining with its alkaline bases, and in this form is excreted, princi- 
pally by the kidneys, as acid salts. 

Temperature. — Medicinal doses have no influence upon temper- 
ature. 

Untoward Action. — Mineral acids under too prolonged admin- 
istration impair the appetite and disturb digestion, occasioning 
toothache and gastric oppression, and at times salivation and diar- 
rhea. They may also produce anemia, paleness of skin, and loss 
of flesh (Nothnagel and Rossbach). When taken for long periods 
and in comparatively large quantities, they have a distinct degen- 
erative action on the heart, the liver, and the kidneys. In the 
blood they cause the production of methemoglobin and induce 
irritative and degenerative changes in the kidney with methemo- 



154 A TEXT-BOOK OF MATERIA MEDICA. 

globinuria. The prolonged use of nitric acid may produce erosion 
of the gums and tongue, with loosening of the teeth. Chromic 
acid and osmic acid act very energetically on the parenchyma of 
the kidneys. 

Poisoning. — The mineral acids when taken in a concentrated 
form and in toxic doses act like corrosive poisons, causing intense 
burning in the stomach and intestines and active gastric inflamma- 
tion. Violent vomiting occurs, the ejected matter containing blood, 
and, in the case of hydrochloric acid, a white cloud of ammonium 
chloride is discerned if the ejecta be placed near the vapor of 
ammonia. 

The respiration is greatly depressed, and there is a strong, 
persistent acid taste in the mouth, the mucous membrane of 
which is discolored, while the tongue is swollen and inflamed. 
There is great thirst, and the pulse becomes rapid and tense. 
The temperature, at first elevated, soon falls below normal, pro- 
found prostration supervening, and death resulting either from 
shock or from secondary inflammation. 

A post-mortem examination shows the results of corrosive poi- 
soning: ulceration or evidences of intense inflammation of the 
mucous membrane of the mouth, esophagus, stomach, and intes- 
tines. Occasionally the walls of the latter are perforated. Should 
death be delayed for some time, there is found fatty degeneration 
of the kidneys and other internal organs. 

Treatment of Poisoning. — This should be prompt. The cautious 
administration of alkalies is indicated to neutralize the acid, though 
the evolution of carbonic-acid gas resulting therefrom may rupture 
the stomach. The stomach should be washed out, and this treat- 
ment followed by demulcent drinks and oil, milk, and eggs. 
Opium may be necessary for the relief of pain, and brandy or 
whiskey subcutaneously in case of collapse. 

Therapeutics. — Externally and Locally. — Hydrochloric acid 
is employed as a caustic in noma and putrid sore throat. Mixed 
with two or three parts of honey, it is an efficient application to 
the throat in diphtheria. Andrews and Morris have recommended 
diluted hydrochloric acid for the removal of sequestra, and Chas- 
saignac has utilized the acid in removing necrosed bone in osteitis 
and caries. 

Nitric acid is a much more powerful caustic, and as such is 
used more extensively than any other mineral acid, because of its 
limited action and the ease with which it is controlled. It is an 



MINERAL ACIDS. 155 

excellent caustic in cases of cancer of the cervix, venereal warts, 
hospital gangrene, phagedenic ulceration, hemorrhoids, and prolapse 
of the rectum, especially in the case of children. In cases also 
of fungoid granidation and excessive hemorrhage from the uterus 
it has been highly recommended. In certain diseases of the 
throat, nose, and ear this acid has been used for the destruction 
of growths, as well as for its escharotic action in ulcerated 
conditions. 

Dermatologists find nitric acid to be an efficient application for 
the removal and destruction of epithelioma, moles, nevi, chloasma, 
etc., caution being exercised in the latter case merely to produce 
an exfoliation of the skin, not sufficient destruction of tissue to 
result in a cicatrix. 

Liveing recommends a veiy weak solution of nitric acid with 
tincture of opium in pruritus. 

Phosphoric acid, in the strength of 50 grains (3.2) to the ounce 
(30.0 Cc.) of distilled water, has been suggested by Grossich in the 
treatment of scrofulous ulcers, and an injection of this solution into 
tuberculous glands of the neck is highly recommended by the same 
authority. 

Sulphuric acid is perhaps the most persistent, irritating, and 
destructive caustic known. Its affinity for water, and its consequent 
extensive action, render it when used alone unfit for caustic pur- 
poses. Mixed with powdered charcoal, however, it forms a paste 
which is an efficient caustic application to chancres, cancers, etc. 
Frazer considers the strong sulphuric acid the best caustic in 
the bites of rabid animals. Diluted solution, in the proportion of 
6 parts of the strong acid to 4 parts of diluted alcohol, has been 
recommended for epistaxis. 

Internally. — Hydrochloric acid, being a normal constituent of 
the stomach, is indicated in certain forms of gastric dyspepsia, par- 
ticularly in the atonic variety. In these latter cases there is usually 
decomposition and fermentation of food, which condition is greatly 
relieved by the administration of pepsin or hydrochloric aoid after 
meals, or the same with bitters before meals. 

In intestinal indigestion hydrochloric acid is an admirable rem- 
edy, given one or two hours after meals. 

The diluted hydrochloric acid is a valuable internal remedy in 
the treatment of diphtheria, and during the course of fevers \ par- 
ticularly typhoid. As a routine treatment in the latter disease the 
author almost invariably gives hydrochloric acid in connection with 



156 A TEXT-BOOK OF MATERIA MEDICA. 

pepsin, finding that it not only allays thirst and moistens the tongue, 
but exerts an antiseptic influence in the bowels, thereby lessening 
the danger of auto-infection and relapse. Alkiewicz recommends 
weak solutions of hydrochloric acid as efficacious in nausea and 
vomiting accompanying certain infectious diseases. 

In certain affections of the skin dependent upon deranged diges- 
tion hydrochloric acid often proves a potent remedy. 

Nitric acid has been used for the same purposes as hydro- 
chloric acid, although for digestive disorders it is inferior to the 
latter drug. 

In intermittent and periodical fevers, however, nitric acid is an 
efficient remedy. In hepatic disorders the diluted nitrohydrochloric 
acid deservedly holds a high place as a remedial agent, and the same 
remedy is frequently employed with success in chronic syphilis. 

In the conditions known as oxaluria and lithemia nitric and 
nitrohydrochloric acids serve an excellent purpose. 

The invaluable preparation introduced by Dr. Hope in 1826, 
known as " Hope's camphor mixture " — a combination of nitrous 
acid, camphor- water, and tincture of opium is of very great service 
as a remedy in serous diarrhea. 

The aphonia of singers and public speakers is often relieved by 
the diluted nitric acid, certain cases of bronchitis being also bene- 
fited by the same remedy. 

Melancholia and the hypochondriasis of dipsomaniacs are some- 
times relieved by diluted nitrohydrochloric acid. 

Phosphoric acid has acquired some reputation as a remedy 
in anemia and as a tonic in wasting diseases and neurasthenia. Its 
value, however, is based more upon theory than upon the results 
of clinical observation. The experience of the author warrants 
the assumption that phosphoric is inferior to hydrochloric acid in 
these conditions, its action being entirely due to increasing diges- 
tion and thereby improving nutrition. 

Probably phosphoric acid is superior to the other mineral acids 
only in its action in diabetes, in which disease it certainly possesses 
a remarkable influence in diminishing thirst and lessening the 
secretion of urine. 

Sulphuric acid, in the author's opinion, is inferior to nitric or 
nitrous acid in serous diarrhea. It is nevertheless an invaluable, as 
well as an old and tried, remedy in cholera, the statistics furnished 
by the Insane Department of the Philadelphia Almshouse during 
an epidemic of this disease appearing to prove its efficacy. 



ORGANIC ACIDS. 157 

This remedy also deserves favorable consideration in the treat- 
ment of acute lead-poisoning. Moreover, in chronic lead-poisoning 
water acidulated with sulphuric acid makes an efficient prophylactic, 
and the remedy has also been suggested as a preventive of Asiatic 
cholera. 

Owing to its astringent and antiseptic properties this acid, par- 
ticularly the aromatic sulphuric acid, proves a good remedy in cer- 
tain cases of diarrhea. It is especially valuable in limiting the 
sweating in phthisis. The same preparation has been found bene- 
ficial in he7natemesis, as well as in intestinal and uterine hemorrhage. 

Where there is a tendency to dissolution of the blood, as in 
scurvy and purpura, sulphuric acid has proved valuable, and it has 
been recommended as an internal remedy in lichen, prurigo, and 
many itching diseases of the skin. 

Contraindications. — Acute inflammation of the stomach, rheu- 
matism, gout, and where the urine is excessively acid and of high 
specific gravity. 

Administration. — Only the diluted acids should be given in- 
ternally, and even these should be further diluted, and taken, if 
possible, through a glass tube, to prevent injury to the enamel of 
the teeth. They are best given after meals, and should not be 
administered for too long a period; and the first indication of 
untoward action, such as griping, diarrhea, etc., is to be taken as a 
warning that the drug must be withdrawn. 



GROUP IV.— ORGANIC ACIDS. 



Acidum Lacticum— Acidi Lactici— Lactic Acid. 

U. S. JP. 

Origin. — An organic acid usually obtained by subjecting milk 
sugar or grape sugar to lactic fermentation. It is composed of 75 
per cent, by weight of Absolute Lactic Acid (CHC 3 H 5 3 = 89.79) 
and 25 per cent, of Water. 

Description and Properties. — A colorless, syrupy liquid, 
odorless, of a purely acid taste, and absorbing moisture on ex- 
posure to damp air. Specific gravity about 1.2 13 at 15 C. (59 
F.). Freely miscible with water, alcohol, or ether; insoluble in 
chloroform, benzin, or carbon disulphide. 

Dose. — 20-30 minims (1.2-1.8 Cc), diluted and sweetened. 



158 A TEXT-BOOK OF MATERIA MEDIC A. 

Official Preparation. 

Syrupus C&lcii Lactophosphatis — Syrupi Calcii Lactophosphatis — Syrup 
of Calcium Lactophosphate. — Dose, 1-2 fluidrachms (3.7-7.3 C). Formula : 
Precipitated Calcium Carbonate, 25 ; Lactic Acid, 60 ; Phosphoric Acid, 36 ; Orange 
Flower Water, 25; Sugar, 700; Water, q. s. ad 1000. 

Antagonists and Incompatibles. — Alkalies and the salts ot 
the mineral acids are incompatible with lactic acid. 

Synergists. — Pepsin, vegetable acids, hydrochloric acid, and 
sodium chloride. 

Physiological Action. — Externally and Locally. — Lactic Acid is 
a caustic to highly organized tissues, resembling the mineral acids in 
its local action. It dissolves false membrane to which it is applied. 

Internally. — Digestive System. — it is thought to be present in 
the stomach during the first forty-five minutes of stomachic diges- 
tion, but cannot be considered a normal constituent of the gastric 
juice. 

Circulatory System. — Being absorbed from the stomach, it com- 
bines with bases in the blood, forming lactates which are rapidly 
converted into carbonates. 

Nervous System. — Large doses greatly depress the nervous sys- 
tem, frequently producing neuralgia and myalgia. 

Absorption and Elimination. — It is absorbed from the stomach, 
undergoes a change in the blood, and is eliminated by the kidneys, 
although, according to Lehmann, when large doses have been 
taken it is found in the urine unchanged ; and we have Benzelius 
and Scherer as authorities that lactic acid can be detected in the 
spleen and the muscular fluid and has been found in the exudates 
of puerperal fever. 

Untoward Action, Poisoning, and Treatment of Poisoning are 
similar to those of the mineral acids. 

Therapeutics. — Externally and Locally. — It has been used 
locally for the same purposes as the mineral acids, but it is 
thought by many clinicans to be superior to the latter in tubercu- 
lous ulceration. In the Hamburg General Hospital, Dr. Zippel 
has employed it with excellent success in the treatment of tubercu- 
lous fistulae. He inserted into the fistula rods made of lactic acid, 
gelatin, and menthol, enveloped with a thin layer of collodion. 

As a solvent of false membranes lactic acid is unquestionably 
superior to the mineral acids, being highly recommended for this 
purpose in diphtheria and croup by such authorities as Morell 
Mackenzie, Lennox Browne, Weber, Dureau, etc. 



ORGANIC ACIDS. 159 

Internally. — Digestive System. — It is used in the digestive dis- 
orders, such as atonic and irritative dyspepsia, and in all those 
derangements of digestion which are benefited by hydrochloric 
acid. In oxaluria, lithemia, chronic cystitis with ammoniacal urine, 
chronic dysentery, and dyspeptic and tuberculous diarrhea it has 
proved an efficient remedy. It has been recommended by Dr. 
Foucaut as a prophylactic in gout. 

Since this drug was suggested by Cantani as a remedy in dia- 
betes mellitus it has been used with varying success. Balfour and 
Foster, as well as Cantani himself, have reported many cases 
which have greatly improved under the administraton of lactic acid 
accompanied by an appropriate dietetic regimen. 

Contraindications. — The same as for mineral acids. 

Administration. — Lactic acid should be given well diluted. 

Acidum Aceticum— Acidi Acetici— Acetic Acid. 

77. 8. P. 

Origin. — A liquid composed of 36 per cent, by weight of Ab- 
solute Acetic Acid (HC 2 H 3 2 = 59.86) and 64 per cent, of Water. 

Description and Properties. — A clear, colorless liquid, having 
a strong, vinegar-like odor, a purely acid taste, and a strongly acid 
reaction. Miscible with water or alcohol in all proportions. 

Dose. — The diluted acid only is given internally. 

Official Preparation. 
Acidum Aceticum Dilutum — Acidi Acetici Diluti — Diluted Acetic Acid. — 
Dose, 1-2 fluidrachms (3.7-7.4 Cc). 

Acidum Citricum— Acidi Citrici— Citric Acid. 

U. S. JP. 

Origin. — An organic acid usually prepared from lemon-juice. 

Description and Properties. — Colorless, translucent, right- 
rhombic prisms ; odorless, having an agreeable, purely acid taste ; 
efflorescent in warm air and deliquescent when exposed to moist 
air. Soluble in 0.63 part Water, in 1.61 parts of alcohol, in about 
0.4 part of boiling water, and in 1.43 parts of boiling alcohol. 

Dose. — 5-20 grains (0.3-1.25 Gm.). 

Official Preparation. 
Syrupus Acidi Citrici— Syrupi Acidi Citrici— Syrup of Citric Acid.— Dose, 

2-8 fluidrachms (7.4-30. Cc.) (10 per cent.). 



160 A TEXT-BOOK OF MATERIA MEDICA. 

Acidum Tartaricum— Acidi Tartarici— Tartaric 
Acid. U.S.I*. 

Origin. — An organic acid usually prepared from argols. 

Description and Properties. — Colorless, translucent, mono- 
clinic prisms, or crystalline crusts, or a white powder; odorless, 
having a purely acid taste, and permanent in air. Soluble in about 
0.8 part of water and in 2.5 parts of alcohol ; also in about 0.5 part 
of boiling water and in 0.2 part of boiling alcohol. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 



Antagonists and Incompatibles. — Alkalies are chemically in- 
compatible with the vegetable acids. With the alkaline, earthy, 
and metallic bases vegetable acids unite to form salts, the acetates 
of which are all soluble. 

Synergists. — Alkalies, and, under certain circumstances, mineral 
acids and the digestive ferments. 

Physiological Action. — Externally and Locally. — The vege- 
table acids have about the same action externally and locally as the 
diluted mineral acids, not caustic but irritant, acetic acid being the 
most powerful and citric acid the weakest. 

Internally. — Digestive System. — Their action on the salivary and 
gastric glands is similar to that of the mineral acids. Their influ- 
ence upon the stomach is not so marked as that of hydrochloric 
acid, though the secretions from the intestinal glands are more 
augmented by vegetable than by mineral acids. Too large or 
prolonged doses of the vegetable acids produce flatulence and 
abdominal pain, and may even occasion diarrhea or enteritis. 

Circulatory System. — Large doses retard and weaken the pulse. 
As with mineral acids, their tendency is to lessen the alkalinity of 
the blood. They unite with alkalies in the stomach to form salts, 
and as such enter the blood, where they are oxidized, the product 
being carbonic acid, which lessens the alkalinity of the blood and 
increases the acidity of the urine. 

Absorption and Elimination. — As stated, vegetable acids unite 
with the alkalies to form salts, as such entering the circulation. 
They are eliminated chiefly by the kidneys, increasing the excre- 
t'ion of both water and solids. Elimination also takes place to a 
considerable extent by the intestinal canal. 

Untoward Action. — Under prolonged dosage there is great ema- 
ciation, deterioration of the blood, and a scorbutic condition. 

Poisoning. — Their toxic effects vary widely. Some are non- 



ORGANIC ACIDS. 161 

toxic — citric ; tartaric is slightly toxic in very large doses ; oxalic 
is a severe poison, the symptoms of which differ in many respects 
from those of poisoning by the mineral acids. The most impor- 
tant symptoms are : Either gastro-intestinal irritation with profound 
collapse or, at times, there is simple collapse with weak heart, 
stupor, unconsciousness, and death, due to central paralysis. 
Poisoning by potassium oxalate adds the effects of potassium, and 
there is more profound cardiac collapse. 

Treatment of Poisoning. — Mild alkalies control the action of the 
milder organic acids. In oxalic acid poisoning — suicidal, or poison- 
ing by potassium oxalate, accidental eating of "sour grass," rhu- 
barb, rumex, or sorrel, oxalis in any form — use gastric lavage, fol- 
lowed by magnesia or chalk, well diluted. Cardiac and respira- 
tory stimulants are necessary. Small doses of opium and strych- 
nine and atropine may be of service. Glacial acetic acid is a pow- 
erful corrosive acid. 

Therapeutics. — Externally and Locally. — All the above-named 
vegetable acids are irritant, more or less antiseptic, and hemo- 
static, acetic acid being the most powerful antiseptic of the three. 
Englemann regards acetic acid as superior to mercuric chloride as 
a disinfectant in obstetrical practice, employing a solution of from 
3 to 5 per cent, for this purpose. A diluted solution is a valuable 
injection in gonorrhea of the female. The glacial acetic acid is a 
powerful caustic, and is much used to dissolve horny growths, warts, 
corns, etc. 

The most important use of acetic acid is in the treatment of 
certain parasitic skin diseases, probably no remedy excelling it in 
cases of ringworm and pityriasis. Diluted acetic acid, or vinegar, 
is an efficient gargle in simple sore throat and the last stage of 
angina of exanthemata, as well as a valuable hemostatic, espe- 
cially in epistaxis. 

Citric acid is but little used locally, although solutions have 
been employed with some success to relieve the itching and sting- 
ing of " prickly heat " and urticaria. A sponge-bath of vinegar 
and water is a grateful and efficient means of reducing temperature 
and checking excessive sweating in disease. 

Tartaric acid has been used by Potter as an application to 
the throat in diphtheria, the effect being to convert the membrane 
into a gelatinous mass which is more easily expelled. 

Internally. — Acetic acid is little used internally. Citric acid, 
however, in the form of a lemonade, is a refreshing refrigerant 
11 



l6z A TEXT-BOOK OF MATERIA MEDICA. 

drink m fevers, while a similar hot lemonade taken at bedtime is a 
valuable and agreeable means of aborting a " cold." Lemon- or 
lime-juice is an infallible prophylactic against scurvy, being unques- 
tionably the most efficient remedy for the disease. 

It is well known by the laity that eating lemons increases the 
functional activity of the liver. Lemons and citric acid, there- 
fore, are efficient remedies in relieving attacks of biliousness and 
catarrhal jaundice, and they even appear to counteract the effects 
of malaria. Lemon-juice is an old and esteemed remedy in acute 
rheumatism. 

Vegetable acids are used for the same disorders of the digestive 
tract as mineral acids, although not so efficient as the latter, espe- 
cially the hydrochloric. Much of the benefit derived from sour 
table-wines is due to the fruit-acids they contain. 

Contraindications. — Ordinarily the same as for mineral acids. 
It is a matter of observation that nursing mothers may produce a 
troublesome diarrhea in the infant by partaking too freely of vine- 
gar or acid fruits. 

Administration. — A solution of citric acid may be made of 
about the acidity of lemon-juice by dissolving 570 grains (36.93 
Gm.) in 1 pint (473.17 Cc.) of distilled water. Vegetable acids 
when taken internally should be mixed with, or dissolved in, water 
and diluted and sweetened, that they may be pleasant to the taste 
and acceptable to the stomach. 



GROUP V— ALKALIES. 



Alkalies are classed as Restoratives because the blood and many 
secretions of the body are normally alkaline in reaction. The fol- 
lowing drugs are numbered among alkalies or antacids : Liquor 
potassae, potassii acetas, potassii bicarbonas, potassii bitartras, 
potassii carbonas, potassii citras, potassii tartras, liquor sodae, sodii 
acetas, sodii bicarbonas, sodii carbonas, sodii carbonas exsiccatus, 
calcii carbonas praecipitatus, creta preparata, liquor calcis, mistura 
cretae, syrupus calcis, lithii benzoas, lithii carbonas, lithii citras, 
lithii citras effervescens, lithii salicylas, magnesii carbonas, ammonii 
carbonas, spiritus ammoniae aromaticus. 



ALKALIES. 163 

Liquor Potassae— Liquoris Potassae— Solution of 
Potash. U.S. P. 

Origin. — An aqueous solution of Potassium Hydrate containing 
about 5 per cent, of the Hydrate. 

Description and Properties. — A clear, colorless liquid, odor- 
less, having a very acrid and caustic taste and a strongly alkaline 
reaction. It should conform to the same reaction and tests as an 
aqueous solution of potassa. (See Potassa.) 

Dose. — 5-20 minims (0.3-1.2 Cc), well diluted. 

Potassii Acetas— Potassii Acetatis— Potassium 
Acetate- U. S. P. 

Origin. — Prepared by the action of Acetic Acid upon Potassium 
Carbonate. 

Description and Properties. — A white powder or crystalline 
masses, of a satiny lustre, odorless, and having a warm, saline 
taste ; very deliquescent on exposure to the air. Soluble in 0.36 
part of water and in 1.9 parts of alcohol ; with increasing tempera- 
ture it becomes much more soluble in both liquids. Potassium 
acetate should be kept in well-stoppered bottles. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Potassii Bicarbonas— Potassii Bicarbonatis— Po- 
tassium Bicarbonate. U.S. I*. 

Origin. — Prepared by the action of Carbon Dioxide upon a 
solution of the Carbonate. 

Description and Properties. — Colorless, transparent, mono- 
clinic prisms, odorless, and having a saline and slightly alkaline 
taste. Permanent in the air, soluble in 3.2 parts of water at 15 C. 
(59 F.) and in 1.9 parts at 50 C. (122 F.). At a higher temper- 
ature the solution rapidly loses carbon dioxide, and, after boiling, 
contains only potassium carbonate. It is almost insoluble in 
alcohol. The drug should be kept in well-stoppered bottles. 

Dose. — 10-40 grains (0.6-2.5 Gm.). 

Potassii Bitartras— Potassii Bitartratis— Potassium 
Bitartrate. U. S. P. 

(Cream of Tartar.) 

Origin. — Prepared by purifying and crystallizing Argol or Crude 
Tartar, a residuum of grape-juice after fermentation. 



1 64 A TEXT-BOOK OF MATERIA MEDICA. 

Description and Properties. — Colorless or slightly opaque, 
rhombic crystals, or a white, somewhat gritty powder, odorless, 
and having a pleasant, acidulous taste ; permanent in the air. Sol- 
uble in about 200 parts of water and in about 16.7 parts of boiling 
water ; very slightly soluble in alcohol. 

Dose. — 10 grains-^ ounce (0.6-16.0 Gm.). 

Official Preparation. 

Ptilvis Jalapse Compfisitus — Piilveris Jalapae Compdsiti — Compound Pow- 
der of Jalap. — Dose, 10-30 grains (0.6-2.0 Gm.) ; used as a hydragogue cathartic. 

Potassii Carbonas— Potassii Carbonatis— Potas- 
sium Carbonate. U. S. JP. 

Origin. — Prepared from the ash obtained from the residue of the 
beet-sugar manufacture. It may also be obtained from wood-ashes. 

Description and Properties. — A white, granular powder, odor- 
less, and having a strongly alkaline taste ; very deliquescent ; solu- 
ble in 1.1 parts of water at 15 C. (59 F.) and in about 0.65 part 
of boiling water; insoluble in alcohol. Its aqueous solution (1 in 
20) has a strongly alkaline reaction upon litmus-paper, and effer- 
vesces with acids. Potassium carbonate should be kept in well- 
stoppered bottles. 

Dose. — 5-30 grains (0.3-2.01 Gm.). 

Potassii Citras— Potassii Citratis— Potassium 
Citrate. U. S. P\ 

Origin. — Prepared by the action of Citric Acid upon a solution 
of Potassium Carbonate. 

Description and Properties. — Transparent, prismatic crystals, 
or a white, granular powder, odorless, and having a cooling, saline 
taste ; deliquescent on exposure to the air. Soluble in 0.6 part of 
water at 15 C. (59 F.), and very soluble in boiling water; feebly 
soluble in alcohol. Potassium citrate should be kept in well-stop- 
pered bottles. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Official Preparations. 

Potassii Citras Effervescens — Effervescent Potassium Citrate. — Dose, 7-45 
grains (0.5-3.0 Gm.). Citric acid, 63; Potassium bicarbonate, 90; Sugar, 47. 

Liquor Potassii Citratis — Solution of Potassium Citrate. — Dose, \-\ ounce 
(15-30 Cc). An aqueous liquid containing in solution about 9 per cent, of anhydrous 
potassium citrate. To be made freshly when wanted. 



ALKALIES. 165 

Potassii Tart ras— Potassii Tart rat is— Potassium 
Tartrate. (Unofficial.) 

Origin. — Prepared by the action of Acid Potassium Tartrate 
upon Potassium Carbonate. 

Description and Properties. — It occurs usually in the form of 
a granular or fine white powder, inodorous, and of a saline, bitter- 
ish taste. Soluble in 0.75 part of water at 2° C. (3 5. 6° F.), and in 
0.47 part of water at 64 C. (147.2 F.). 

Dose. — 30 grains-^ ounce (2.0-16.0 Gm.). 

PREPARATIONS OF SODIUM. 

Liquor Sodae— Liquoris Sodae— Solution of Soda. 

77. S. P. 

(Solution of Sodium Hydrate.) 

Origin. — An aqueous solution of Sodium Hydrate (NAOH = 
39.96), containing about 5 per cent, of the Hydrate. 

Description and Properties. — A clear, colorless liquid, odor- 
less, having a very acrid and caustic taste and a strongly alkaline 
reaction. 

Dose. — 5-20 minims (0.3-1.8 Cc). 

Sodii Acetas— Sodii Acetatis— Sodium Acetate. 

77. S. P. 

Origin. — It may be obtained by neutralizing Acetic Acid with 
Sodium Carbonate. The usual article, however, is manufactured on 
a large scale in the United States in the process of purifying acetic 
acid from wood vinegar. 

Description and Properties. — Colorless, transparent, mono- 
clinic prisms, or a granular, crystalline powder, odorless, and having 
a cooling, saline taste ; efflorescent in warm, dry air. Soluble in 
1.4 parts of water and in 30 parts of alcohol; also in 0.5 part of 
boiling water and in 2 parts of boiling alcohol. Sodium acetate 
should be kept in well-stoppered bottles. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Sodii Bicarbonas— Sodii Bicarbonatis— Sodium 
Bicarbonate. U. S. I*. 

Origin. — Prepared by saturating a mixture of 2 parts o( Crys- 
tallized and 3 parts of Dried Sodium Carbonate with Carbon Diox- 



166 A TEXT-BOOK OF MATERIA MEDICA. 

ide, generated by the action of hydrochloric acid upon marble. 
The damp Salt formed is shaken with half its weight of Distilled 
Water, the undissolved portion being dried by exposure to the air. 

Description and Properties. — A white, opaque powder, odor- 
less, and having a cooling, mildly alkaline taste ; permanent in dry, 
but slowly decomposed in moist, air. Soluble in 11.3 parts of 
water at 15 C. (59 F.); above that temperature the solution loses 
carbon dioxide, and at a boiling heat the salt is entirely converted 
into normal carbonate. Insoluble in alcohol and ether. The drug 
should be kept in well-closed vessels, in a cool place. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Official Preparations. 

Mistura Rhei et Sodse — Misturae Rhei et Sodae — Mixture of Rhubarb and 
Soda. — Dose, ^-2 fluidounces (7.4-59 Cc). 

Trochisci Sodii Bicarbonatis — Trochlscos (ace.) Sodii Bicarbonatis — 
Troches of Sodium Bicarbonate. — Dose, 1 to 6 troches. 

Sodii Carb5nas— Sodii Carbonatis— Sodium 
Carbonate. V. S. P. 

Origin. — Obtained from Sodium Sulphate and Sodium Chloride, 
but chiefly by a complicated process, known as Leblanc's, from 
Sodium Sulphate, which is mixed with Chalk and Coal, the mixture 
ignited, and the resultant mass exhausted with Water and concen- 
trated, the carbonate separating from the hot liquid being purified. 

Description and Properties. — Colorless, monoclinic crystals, 
having a strongly alkaline taste. In dry air the salt effloresces, 
and if left exposed soon loses about half its water of crystallization 
(31.46 per cent, of its weight), becoming a white powder. Soluble 
in 1.6 parts of water at 15 C. (59 R), in 0.09 part at 38 C. 
(100.4 F.), in 0.2 part of boiling water, and in 1.02 parts of glycerin ; 
insoluble in alcohol and ether. The aqueous solution gives an 
alkaline reaction with litmus-paper, and effervesces strongly with 
acids. The drug should be kept in well-closed vessels. 

Dose. — 10-30 grains (.06-2.0 Gm.). 

Official Preparation. 

Sodii Carbonas Exsiccatus — Sodii Carbonatis Exsiccati — Dried Sodium 
Carbonate. — Description and Properties. — A loose white powder, conforming to the 
reactions and tests for sodii carbonas. 

Dose. — 3-10 grains (0.2-0.6 Gm.). 



ALKALIES. 167 



PREPARATIONS OF CALCIUM. 

Calcii Carbonas Praecipitatus— Calcii Carbonatis 
Praecipitati— Precipitated Calcium Carbonate. 
U. S. P. 

Origin. — Prepared by mixing aqueous solutions of Calcium 
Chloride and Sodium Carbonate, the resulting precipitate of Cal- 
cium Carbonate being purified. 

Description and Properties. — A fine white powder, without 
odor or taste, permanent in the air. Nearly insoluble in water, its 
solubility being increased by the presence of ammonium salts, and 
especially by carbonic acid, and diminished by alkali hydrates. 
Insoluble in alcohol, but in diluted acetic, hydrochloric, or nitric 
acid completely soluble, with effervescence. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

Creta Praeparata— Cretae Praeparatae— Prepared 
Chalk. U.S.JP. 

Origin. — Native, friable Calcium Carbonate freed from most im- 
purities by elutriation. 

Description and Properties. — A white, amorphous powder, 
often moulded into conical drops, odorless and tasteless, permanent 
in the air. Almost insoluble in water ; insoluble in alcohol ; soluble 
in diluted acetic, hydrochloric, or nitric acid, with copious efferves- 
cence, but without leaving more than a trifling residue. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 

Official Preparations. 

Hydrargyrum cum Creta— HydrSrgyri cum Creta— Mercury with Chalk.— 
Dose, 2-10 grains (0.12-0.6 Gm.). (Described under Hydrargyrum^ 

Ptilvis Cretae CompSsitus— Pulveris Cretae Compftsiti —Compound Chalk 
Powder. — Dose, 20-60 grains (1.30-4.0 Gm.). 

Trochlsci Cretae— Trochlscos (ace.) Cretae— Troches of Chalk.— Dose, ad 
libitum. 

Unofficial Preparations. 

Ptilvis Cretae Aromaticus — Pulveris Cretae Arom^tici— Aromatic Powder 
of Chalk. — Dose, 30-60 grains (2.0-4,0 Gm.). A mixture of Aromatics with 
Chalk. 

Ptilvis Cretae Aromaticus cum Opio— Pulveris Cretae Arom^tici cum Opio 
— Aromatic Powder of Chalk and Opium.— Dose, 10-20 grains (0.6-1.30 Gm.). 
1 grain (.06 Gm.) of Opium in every 40 grains (2.5 Gm.) of the previous mixture. 



168 A TEXT-BOOK OF MA TERIA MEDICA. 

Liquor Calcis— Liquoris Calcis— Solution of Lime. 

U. S. I>. 

(Solution of Calcium Hydrate; Lime Water.) 

Origin. — A saturated, aqueous solution of Calcium Hydrate. 

Description and Properties. — A clear, colorless liquid, without 
odor, and having a saline and feebly caustic taste. It absorbs 
carbon dioxide from the air, so that a pellicle of calcium carbonate 
forms on the surface of the liquid. On being heated it becomes 
turbid through separation of calcium hydrate, which redissolves 
when the liquid is cooled. It gives a strong alkaline reaction with 
litmus paper. 

Dose. — -|~4 ounces (15.0-118.3 Cc). 

Official Preparations. 

LinimSntum C&lcis — Linimfcnti C&lcis — Lime Liniment (Carron Oil). — 
For external use. 

Mistura Cretae — Misturse Cretse — Chalk Mixture. — Dose, 1-4 fluidrachms 
(4.0-15. Cc). Compound Chalk Powder, Cinnamon Water, and Water. 

Syrupus Calcis — Syrupi Calcis — Syrup of Lime. — Dose, \-2. fluidrachms 
(1.8-7.4 Cc). 

PREPARATIONS OF LITHIUM. 

LTthii Carbonas— Lithii Carbonatis— Lithium 
Carbonate. IT. S. I*. 

Origin. — Lithium is found in many mineral waters, the carbon- 
ate being prepared from lepidolite. 

Description and Properties. — A light white powder, odorless, 
and having an alkaline taste ; permanent in the air. Soluble in 80 
parts of water and 140 parts of boiling water; much more soluble 
in water saturated with carbon dioxide ; insoluble in alcohol, but 
soluble in diluted acids, with active effervescence. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Lithii Citras— LTthii Citratis— Lithium Citrate. 

U. S. JP. 

Origin. — Prepared by adding Lithium Carbonate to a solution 
of Citric Acid. 

Description and Properties. — A white powder, odorless, and 
having a cooling, faintly alkaline taste ; deliquescent on exposure 
to the air. Soluble in 2 parts of water and in 0.5 part of boiling 



ALKALIES. 169 

water ; almost insoluble in alcohol or ether. Lithium citrate should 
be kept in well-stoppered bottles. 
Dose. — 2-10 grains (0.12-0.6 Gm.). 

Official Preparation. 

Lithii Cftras Effervgscens — Othii Citratis Effervescentis— Effervescent 
Lithium Citrate. — Dose, 1-2 drachms (4.0-8.0 Gm.). 

PREPARATIONS OF MAGNESIUM. 

Magnesia— Magnesiae— Magnesia. 17". S. P. 

(Light Magnesia; Calcined Magnesia.) 

Origin.— Prepared by subjecting Magnesium Carbonate to a low 
red heat in a Cornish or Hessian crucible closed loosely by a lid. 

Description and Properties. — A white, very light, and very 
fine powder, without odor, and having an earthy, but not a saline, 
taste. On exposure to the air it slowly absorbs moisture and car- 
bon dioxide. Almost insoluble in water and insoluble in alcohol, 
but soluble in diluted acids. Magnesia should be kept in well- 
closed vessels. 

Dose. — As an antacid, 10-15 grains (0.6-1.0 Gm.). 

Magnesia Ponderosa— Magnesiae Ponderosae— 
Heavy Magnesia, U. S. P. 

(Heavy Magnesia.) 
A white, dense, and very fine powder, which should conform to 
the reactions and tests for magnesia, from which it differs in not 
readily uniting with water to form a gelatinous hydrate. 

Official Preparation. 

Ptilvis Rhei Comp5situs — Piilveris Rhei CompSsiti— Compound Powder 
of Rhubarb. — Dose, as a laxative, 20-60 grains (1.30-4.0 Gm.). Formula: Rhubarb, 
25 ; Magnesia, 65 ; Ginger, 10 parts. 

Magnesii Carbonas— Magnesii Carbonatis— 
Magnesium Carbonate. TJ. S. P. 

Origin. — Prepared by evaporating to dryness the mixed solu- 
tions of Magnesium Sulphate and Sodium Carbonate, and purifying 
and drying the residue. 

Description and Properties. — Light, white, friable masses, or 
a light, white powder, without odor, and having a slightly earthy 
taste ; permanent in the air. Almost insoluble in water, to which, 
however, it imparts a slightly alkaline reaction ; insoluble in alco- 
hol, but soluble in diluted acids, with active effervescence. 

Dose. — As an antacid, 5-20 grains (0.3-1.3 Gm.). 



170 A TEXT-BOOK OF MATERIA MEDIC A. 

PREPARATIONS OF AMMONIUM. 

Amm5nii Carbonas— Amm5nii Carbonatis— 
Ammonium Carbonate. U.S.I*. 

Origin. — Prepared by a complicated process by heating in an 
iron or earthen retort a mixture of Sal Ammoniac and Chalk. 

Description and Properties. — White, hard, translucent, striated 
masses, having a strongly ammoniacal odor without empyreuma, 
and a sharp, saline taste. On exposure to the air the salt loses 
both ammonia and carbonic acid, becoming opaque, and is finally 
converted into friable porous lumps or a white powder. Slowly 
but completely soluble in about 5 parts of water at 15 C. (59 F.) f 
and decomposed by hot water, with the evolution of carbonic acid 
and ammonia. By prolonged boiling with water the salt is com- 
pletely dissipated. The aqueous solution possesses a strongly 
alkaline reaction and effervesces with acids. 

Dose. — 3-10 grains (0.18-0.6 Gm.). 

Official Preparation. 

Spiritus Ammoniae AromSticus — Spiritus Ammoniae Aromattici — Aromatic 
Spirit of Ammonia. — Composition: Ammonium Carbonate, Ammonia Water, Aro- 
matic Oils, Alcohol, and Water. 

Description and Properties. — A nearly colorless liquid when freshly prepared, 
but gradually acquiring a somewhat darker tint. It has a pungent, ammoniacal odor 
and taste. 

Dose. — |-l fluidrachm (1.8-3.7 Cc). 



Antagonists and Incompatibles. — The alkalies and their car- 
bonates are incompatible with acids and with metallic salts. The 
ammonium carbonate is incompatible with the acidulous salts and 
with lime water. 

Synergists. — Agents promoting waste, such as vegetable acids, 
mercury, iodine, etc., increase the therapeutic activity of the 
alkalies. 

Physiological Action. — The alkalies mentioned in this group 
may be divided into direct antacids, or those which neutralize or 
lessen the acidity of the stomach, and indirect antacids, or those 
which, being oxidized in the blood, are excreted as carbonates, 
diminishing the acidity of the urine and increasing the alkalinity of 
the blood, although not influencing the acidity in the stomach. 

The direct antacids are lime water, prepared chalk, and magnesia. 

The indirect antacids are potassium acetate, bitartrate, citrate, 
and tartrate, sodium acetate, and lithium citrate. 



ALKALIES. 171 

The following alkalies are both direct and indirect antacids: 
solution of potassa, solution of soda, carbonates and bicarbonates 
of potassium, sodium, lithium, magnesium, and ammonium. 

The physiological action of the various alkalies will now be 
considered in detail. 

Externally and Locally. — The hydrates of potassium and sodium 
are caustic and rubefacient. The solutions of soda and potassa, 
when applied undiluted, irritate the surface of the skin and soften 
and dissolve the epidermis and horny tissues, uniting with the 
albumin of the various structures to form a soluble alkali-albu- 
minate. The carbonates and bicarbonates exert a similar, though 
much weaker, action, while the acetates, bitartrates, citrates, and 
tartrates have no local influence. 

The ammonium salts do not affect the epidermis in the manner 
of those previously mentioned, penetrating without dissolving it, 
irritating the underlying structures, and inducing an effusion of 
lymph, thus acting as vesicants. Should a strong solution of 
ammonia be applied to the skin and evaporation be prevented, 
suppuration and sloughing may ensue. 

Internally. — Digestive System. — Potassium salts in small doses 
promote the secretion of gastric juice, thus obeying the law by 
which alkalies augment acid secretions. Large doses neutralize 
free acid in the stomach, and, by rendering the chyme neutral or 
alkaline, interfere with the secretion from the pancreas, liver, and 
intestines, thereby deranging digestion. 

The statement that alkaline carbonates given before a meal 
increase the secretion of gastric juice seems to rest more on clinical 
interpretation than on experimental evidence, for lower animals, at 
least. The so-called " law of contraries," taught for so many years, 
has little foundation in experimental work. The therapeutic re- 
sults sometimes obtained must be explained on other grounds. 

Circulatory System. — The alkaline salts of potassium, by lessen- 
ing the acidity of the gastric juice and entering the circulation, 
increase the alkalinity of the blood. The bicarbonates, however, 
taken in large doses upon an empty stomach, enter the circulation 
unchanged, where, by decomposing the neutral phosphate of 
sodium present, they form the acid phosphate of sodium, reducing 
the alkalinity of the blood and increasing the acidity of the urine. 

Far different are the effects of these alkalies when taken after 
meals, the salts being then decomposed in the stomach by the 
acid gastric juice, the alkaline base increasing the alkalinity of the 
blood. 



172 A TEXT-BOOK OF MATERIA MEDICA. 

The acetates, citrates, and bitartrates enter the blood unchanged. 
The acid radical being destroyed, and the base combining with the 
carbon dioxide formed, the salts are converted into the alkaline car- 
bonates, increasing the alkalinity of the blood and urine. It is 
believed that the amount of hemoglobin is increased by the potas- 
sium salts when the blood is deficient in this substance, though 
large doses interfere with the ozonizing function of the red blood- 
corpuscles. 

Should the caustic alkalies be injected directly into the blood, 
death quickly ensues from coagulation of that fluid, arising from 
excessive formation of alkali-albuminate. Under very large or 
poisonous doses the heart-muscle is weakened, decreasing the force 
of its contractions, arrest taking place in diastole. Even medicinal 
doses, if long, continued, may occasion cardiac depression, diminish- 
ing the force of the circulation. Small doses may increase blood- 
pressure, though the pulse-rate be diminished. Brunton and Cash 
have demonstrated that minute amounts of potassium salts applied 
to muscle increase its contractile power, while large doses diminish 
or paralyze this force. 

Nervous System. — When potassium salts are administered in 
medicinal doses and for a reasonable length of time, no important 
action upon the nervous system is produced ; but if excessive doses 
be taken, the nerve-centers and motor nerves are paralyzed, after a 
period of temporary excitement. Owing, however, to the fact that 
potassium is a protoplasmic poison, affecting alike the muscles and 
nerve-tissues, its salts should not be given in full doses for too long 
a period without counteracting their depressing influence by the use 
of muscle- and nerve-tonics. 

Respiratory System. — The only action of importance upon the 
respiratory system is the increased amount and diminished viscidity 
of the secretion from the bronchial tubes. 

Absorption and Elimination. — The potassium salts possess very 
high diffusive power. They are easily and quickly absorbed and 
rapidly excreted, the salts with vegetable acids being eliminated 
as alkaline carbonates, rendering the urine alkaline. Salts of potas- 
sium are chiefly eliminated by the kidneys, though the process 
takes place to some extent through the bronchial mucous mem- 
brane and other secretions. They are active diuretics, increasing 
the amount of water and, by stimulating the renal epithelium, 
augmenting the excretion of solids. The uric acid is greatly dimin- 
ished, being converted into urea, and as such eliminated, showing 
that the alkalies increase oxidation and promote waste. 



ALKALIES. 173 

Temperature. — Medicinal doses have no effect upon temperature. 

Untoward Action. — Under prolonged dosage the digestion be- 
comes impaired. There is present paralysis of the muscular fibers 
of the intestines, accompanied by diarrhea or constipation and tym- 
panites. There may be also present emaciation, muscular weakness, 
nervous prostration, and anemia. 

Poisoning. — The caustic preparations of potassium produce all 
the symptoms of a corrosive mineral poison, somewhat resembling 
the poisonous action of the mineral acids already described. Death 
is occasionally preceded by convulsions, the heart's action being 
arrested before respiratory failure. The carbonates and bicarbonates 
and the salts of vegetable acids are not considered poisonous, nor 
do they produce the corrosive effects of caustic potash or its solution. 

Treatment of Poisoning. — Vegetable acids are chemically incom- 
patible, and should be given freely, together with oils and demul- 
cent drinks as protectives, and opium, if necessary, to relieve pain. 
Cardiac stimulants — digitalis, brandy, caffeine, etc. — may be required 
to sustain the heart, to be given hypodermically. 

The Comparative Action of the Alkalies. — Sodium salts in 
their action are analogous to potassium, although less irritating 
to the gastro-intestinal tract. They are also less depressing to 
the circulatory, muscular, and nervous systems. They are neither 
absorbed nor eliminated so rapidly, and are consequently less 
active as diuretics. They are not nearly so powerful solvents of 
uric acid, and are therefore inferior to the potassium salts in gout. 
Indeed, the nodules, known as " chalk-stones," frequently found 
upon the joints of gouty patients, are composed of urate of sodium. 

Lithium salts closely resemble in their effects those of potas- 
sium, their action upon the nerves and muscles, however, being 
less powerful. The contractile force of muscle is invariably di- 
minished by lithium and increased by potassium. As a solvent 
of uric acid, lithium is the most powerful of all the alkalies, the 
urates, formed under the administration of the carbonate or citrate, 
being extremely soluble, rendering the alkaline salts of lithium 
superior to the other alkalies in gout and in the uric-acid diathesis. 

Calcium salts are more sedative and astringent in their action 
upon the gastro-intestinal tract than the other alkalies, and are 
direct antacids. They tend to produce constipation. The nervous 
and muscular systems are less affected by these salts than by the 
remaining alkalies, the contractile muscular force, however, being 
increased by calcium. They are less readily absorbed and excreted 



174 A TEXT-BOOK OF MA TERIA MEDICA. 

than the foregoing alkalies, and less active in increasing the alka- 
linity of the urine. 

Magnesium Salts. — Magnesia and the magnesium carbonates 
are direct antacids and sedative to the stomach, acting upon the 
intestinal canal as saline cathartics. In their influence upon the 
circulatory system they are feebler than, but similar to, the potas- 
sium salts, slightly increasing the alkalinity of the blood. They 
are not so readily absorbed, nor so rapidly excreted, as the salts 
of potassium and sodium, while increasing the amount of water 
and solids excreted and acting as solvents of uric acid. 

Ammonium Salts. — These preparations are used rather as car- 
diac stimulants, their physiological action being more extensively 
considered under that group. As antacids their action may be 
briefly compared with that of the other alkalies. Their effect upon 
the gastric juice and its secretion is similar to that of the car- 
bonates and bicarbonates above mentioned. They dilate the blood- 
vessels of the stomach, augmenting the blood-supply and pro- 
ducing a sensation of warmth in the epigastrium. Lethal doses act 
as emetics. They increase the glycogenic function of the liver and 
stimulate the circulatory system, elevating the pulse-rate and rais- 
ing arterial tension. In medicinal doses they stimulate the spinal 
cord, motor nerves, and muscles, while toxic doses paralyze these 
structures. They prevent the coagulation of the blood and lessen 
the oxygen-carrying power of the red corpuscles. By them also 
the respirations are increased in frequency. 

The salts of ammonium are quickly absorbed and undergo oxi- 
dation in the body, augmenting the amount of uric acid and urea in 
the urine, thereby increasing its acidity to some extent. 

As regards the poisonous activity of the alkalies mentioned, 
ammonium ranks next to potassium, the most toxic of all. 

Therapeutics. — Externally and Locally. — Norton has recom- 
mended liquor potass^e in ingrowing toe-nail, the solution being 
applied to the nail, which is soon rendered so soft that it can be easily 
scraped without causing pain. The same remedy is used in many 
diseases of the skin to allay itching and soften the horny epithelium. 
It is also employed extensively in diseases of the ear and throat, and 
in the proportion of I part to 10 of water it is very effective in 
softening impacted cerumen. 

The potassium carbonate in solution is frequently used in various 
pruriginous diseases of the skin, being a highly efficient antipruritic. 

The detergent and sialagogue properties of potassium citrate 
and tartrate are rendered serviceable in certain diseases of the mouth. 



ALKALIES, 175 

Sodium bicarbonate is a deservedly popular dressing for burns, 
and pain and swelling of the joints in acute articular rheumatism are 
sometimes greatly relieved by enveloping the articulations in a hot 
solution rendered alkaline with this salt. T. MichailofT highly 
recommends sodium bicarbonate in granular tonsillitis and pharyn- 
gitis, the powdered salt being applied every two or three hours. 
In diseases of the ear it is used for the same purposes as the potas- 
sium preparations above mentioned. It is one of the ingredients 
of " Dobell's Solution," which is an effective antiseptic wash in 
nasal catarrh, and the solution of sodium bicarbonate has been sug- 
gested by Forchheimer as a valuable remedy in thrush or aphthce. 

Sodium carbonate may be used for the same purposes as the 
bicarbonate, though probably inferior to it in all cases save infantile 
eczema capitis, in which condition it is a most valuable remedy for 
softening the eczematous crusts. 

Prepared chalk is an ingredient of many ointments used in the 
treatment of erysipelas and subacute . eczema. Lime water, mixed 
with equal parts of linseed or olive oil, is highly prized as a dress- 
ing for burns, and the efficiency of the " black " and " yellow " 
washes in the treatment of venereal sores is too well known to 
require further testimony in their favor. These latter preparations 
also make excellent applications in acute eczema. Lime water may 
sometimes be used with advantage in leucorrhea and vaginitis. 

Lithii carbonas, in the proportion of 5 grains (0.3 Gm.) to 
I ounce (30.0 Cc.) of water, is highly recommended by Garrod 
for the removal of gouty deposits, the solution being kept con- 
stantly applied to the parts by means of lint or absorbent cotton. 

Magnesium carbonate makes an efficient dusting powder in der- 
matitis and irritable conditions of the skin. Ammonium carbonate 
mixed with lanolin readily dissolves the epidermic scales of psori- 
asis, and the aromatic spirit of ammonia is a grateful application 
to the scalp in pityriasis. 

Internally. — Digestive System. — The carbonates and bicarbon- 
ates, when given before meals, serve to increase the flow of gastric 
juice. They act as sedatives to the stomach, particularly in painful 
conditions arising from a deficient secretion of gastric juice. As 
antacids, when given after meals, they are very useful in counter- 
acting excessive acidity of the stomach. The acidity due to the 
formation of fatty acids, the result of defective digestion, is not 
relieved by the administration of these salts after meals, but if 
taken before meals they are valuable in correcting the deficiency 



176 A TEXT-BOOK OF MATERIA MEDIC A. 

of gastric secretion to which the disordered digestion is due. In 
atonic dyspepsia these preparations administered with vegetable 
bitters serve a useful purpose. 

The bicarbonates and the salts of the vegetable acids, by increas- 
ing the alkalinity of the blood, are of great value in gout, the lithia 
salts being the most efficient in this condition. They are also of 
great benefit in the treatment of acute rheumatism. The extensive 
experience of the author in connection with the latter disease justi- 
fies the belief that in the treatment of it alkalies are far superior 
to any other drugs, salicylic acid not excepted. 

While it is admitted that the treatment of acute rheumatism by 
alkalies alone will not shorten the course of the disease so readily 
as the employment of salicylates, there is certainly less danger of 
heart-complications, the period of convalescence is reduced, and 
the tendency to relapse lessened by the use of alkaline remedies. 

Even in chronic rheumatism where no serious renal derange- 
ments exist the mild alkalies, which are well borne by the stomach, 
are undoubtedly indicated, since it is well known that in chronically 
rheumatic subjects there is a decidedly lessened alkalinity of the 
blood. It is, perhaps, unnecessary to add that in the treatment of 
these cases proper hygiene, food, and cholagogues are important 
adjuncts to successful management. The author is disposed to go 
still further and urgently recommend complete alkalinization of the 
system, in connection with other therapeutic measures, in dealing 
with rheumatoid arthritis. 

The acetates, bitartrates, and citrates are efficient diuretics, 
cathartics, and diaphoretics, the first-named salts being superior 
diuretics, the potassium bitartrate a reliable cathartic, and the 
citrates active diaphoretics. 

In lithemia these salts serve a valuable purpose by rendering 
the urine persistently alkaline, retarding the formation of uric-acid 
calculi, and even dissolving small calculi of this variety. 

In chronic Bright' s disease the acetates and citrates are fre- 
quently indicated for their diuretic action, while potassium bi- 
tartrate is one of the most effective cathartics and diuretics in 
acute nephritis and cardiac dropsy. 

Lime water is a useful remedy for vomiting — whether due to 
irritability, gastric ulcer, or cancer — and is also valuable in check- 
ing this symptom in pulmonary tubercidosis. It is an important 
adjunct to milk, in preventing the formation of curds and relieving 
infantile vomiting. 

In the acute mycotic diarrhea of children, characterized by acid 



ALKALIES. 177 

gastro-intestinal fermentation, the foregoing combination is ex- 
tremely useful. The symptoms also of chronic diarrhea and dys- 
entery are often mitigated by this simple remedy. 

Lime water is without doubt a very efficient remedy in diabetes 
insipidus, and may also exert a favorable influence in chronic bron- 
chitis by checking and otherwise modifying the mucous secretion. 
It should be remembered that this preparation is a valuable anti- 
dote in arsenical poisoning. The syrup of lime is a very inferior 
remedy, the sugar which it contains neutralizing the beneficial 
action which the lime alone might exert. 

Prepared chalk, or chalk mixture, is useful in relieving the 
premonitory diarrhea of cholera, and simple diarrheas of children, 
with greenish acid stools and flatulent distention of the abdo- 
men, are greatly benefited by this preparation. It is very neces- 
sary, however, that the chalk mixture be freshly prepared, the 
cinnamon water it contains being liable with age to fungoid con- 
tamination, and the propagation of microorganisms, which might 
seriously aggravate the condition for which the remedy is given, 
occasioning vomiting, etc. This old standby is being superseded, 
however, in later-day pediatrics by the use of mild salines and intes- 
tinal antiseptics. Chalk mixture is still useful, however, in diar- 
rheas not due to bacterial causes. 

Magnesia is an invaluable antacid in gastric disorders, and 
especially in aphthce attending infantile diarrhea. 

As above stated, the lithium preparations are unquestionably 
superior to the other alkalies in the gouty and uric-acid diatheses. 

The ammonium preparations are useful antacids, being particu- 
larly efficacious in the dyspepsia of drunkards to allay nausea and 
vomiting, render the mucus less viscid, and act as stimulants to 
the circulation. Their excitant qualities, together with their prop- 
erty of modifying the mucous secretion, render them also of value 
in appropriate cases of subacute and chronic bronchitis. The re- 
maining important uses of the ammonium preparations will be 
considered under " Cardiac Stimulants." 

In conclusion, it may be well to mention the value of alkalies 
in aiding the digestion of fats, and as efficient remedies in the dys- 
pepsia and indigestion from which obese, gouty, and rheumatic 
subjects frequently suffer. 

The virtue and uses of mineral waters will be fully discussed in 
the following group devoted to the subject. 

Contraindications. — Alkalies are contraindicated in the phos- 
phatic diathesis, since there is danger of the formation of phosphatic 
12 



178 A TEXT-BOOK OF MATERIA MEDICA. 

calculi. The calcium preparations should not be given to patients 
suffering from oxaluria. 

Administration. — The alkalies should invariably be adminis- 
tered largely diluted, thus favoring absorption and preventing their 
irritant action upon the gastro-intestinal mucous membrane. The 
time of administration — whether before or after meals — will depend 
entirely upon the effect desired, a thorough knowledge of their 
action as above given being necessary to an intelligent and proper 
use of the various preparations. 



GROUP VI.— MINERAL WATERS. 

The line of demarcation between mineral and ordinary waters 
cannot be definitely drawn. Although in the former there is usu- 
ally present an excess of mineral constituents or of temperature, 
some drinking waters contain more mineral ingredients than others, 
while many very pure waters, both cold and warm, have been re- 
garded for ages as mineral springs. As Pliny observed, waters are 
such as the soil through which they flow, it being a matter of 
observation that chalk or limestone formations, for instance, natu- 
rally impregnate with their normal constituents the springs originat- 
ing in them. Still, it is impossible to determine with certainty the 
depth from which these waters flow, or to ascertain the various dis- 
tances from the surface at which they assimilate foreign ingredients. 

Nor are the geographical distribution and altitude of mineral 
springs less remarkable than the diversity of their constituents. 
Although especially abundant in volcanic regions, mineral springs 
are by no means confined to them. They have been found on 
alpine heights — even at the snow-line in the Himalayas — and they 
rise from the bottom of the sea, as at Baiae and Ischia. 

The foreign ingredients of mineral waters, as shown by analysis, 
are very numerous, some of them occurring in exceedingly minute, 
others in large, quantities. Among them are soda, magnesium, 
calcium, potash, alumina, iron, boron, iodine, bromine, arsenic, 
lithium, cesium, rubidium, fluorine, barium, copper, zinc, manga- 
nese, strontium, silica, phosphorus, besides extractive substances 
and various organic deposits known under various names. The 
constituent gases include carbonic and hydrosulphuric acids, nitro- 
gen, oxygen, hydrogen, and ammonia. Of all these, by far the 



MINERAL WATERS. 179 

most important from a therapeutic point of view are sodium, mag- 
nesium, iron, carbonic acid, sulphur, and perhaps hydrosulphuric 
acid. The various substances detected separately by chemists are 
in their analyses combined by them into various salts — if not with 
absolute certainty, undoubtedly with a close approximation to it. 

These combinations are very numerous, some waters containing 
from 10 to 20 per cent, of them; yet there are always certain pre- 
dominating constituents which mark the character of the spring, 
while many substances, such as cesium, rubidium, or fluorine, occur 
in mere traces and must be regarded as unimportant. 

Mineral waters may be considered, therefore, as weaker or 
stronger solutions of salts and gases of higher or lower tempera- 
ture, although the quantity of saline ingredients commonly bears 
but a very small proportion to that of the fluids containing them. 
For purposes of therapy they are used either externally in the form 
of baths or internally as beverages. With regard to the former 
use — or, to speak technically, balneotherapy — the scope of the 
present work precludes treatment in extenso. Enough to say that 
in certain conditions the system is undoubtedly benefited by resort 
to baths of various characters, especially when accompanied by the 
accessory aid of well-considered diet and regimen. 

The literature connected with the subject of potable waters is 
voluminous, yet the deductions drawn by various observers touch- 
ing their efficacy and in relation to the comparative value of natural 
springs are too frequently colored by individual bias, or based upon 
too hasty analysis to furnish infallible data or warrant the definite 
statement possible in ordinary therapeutics. That certain waters 
charged with foreign ingredients when ingested react upon the 
system favorably in the case of certain disorders it were futile to 
deny. Yet even here there are subsidiary considerations not to be 
ignored ; and it is an open question how far the patient may be 
relieved by the potency of the remedy per se, or whether the col- 
lateral aids of environment, climate, altitude, temperature, etc. may 
not have an important bearing upon beneficial results. 

It has been well observed that in the case of water taken in situ 
the curative atmosphere of the surroundings, the favorable season 
of the year, the reflex influence of social amenities, and freedom 
from customary cares, aided by studied regimen under constant 
medical supervision, play no unimportant part in the alleviation of 
positive or imaginary disorders. The maxim, "Amuse the patient 
and let nature work the cure," seems not wholly inapplicable to 



180 A TEXT-BOOK OF MATERIA MEDICA. 

many fashionable resorts where a constant round of gayety acts as 
a practical, though imperceptible, tonic or stimulant upon subjects 
of certain nervous susceptibilities. These considerations are no 
less forcible in the case of American " watering-places " than in 
those of the more famous resorts of Europe. 

Various attempts have been made to range mineral waters 
according to their therapeutic action, their external and internal 
effects physiologically, and, most frequently, according to their 
chemical composition. Yet their influence is so dependent upon 
idiosyncrasy and their constituents so varied that it is wellnigh 
impossible to select a definite system free from objections, although 
a scientific classification, uniformly adopted, would undoubtedly 
promote their rational employment. Many sulphur waters are 
practically earthy or saline ones, yet the presence of minute quan- 
tities of hydrosulphuric acid, an ingredient so palpable as always 
to attract attention, has determined a classification obviously at 
variance with natural fact. The general rule has been to class 
waters under the head of their predominating elements, the desid- 
eratum being comparative simplicity untrammelled by theoretical 
considerations. In this view perhaps the most convenient arrange- 
ment of native mineral springs is that subjoined, adopted by Dr. 
A. N. Bell and widely accepted by writers on therapeutics : 

Alkaline. — These waters owe their chief therapeutic value to 
the alkaline salts they contain. They are rich in alkaline car- 
bonates, especially the sodium carbonate. Other substances are 
included among their ingredients, many of them strongly charged 
with carbonic-acid gas, which may possibly contribute to their 
physiological activity. 

Saline. — These either contain (i) chloride of sodium as the 
principal ingredient, or (2) are largely impregnated with the sul- 
phates of sodium and magnesium. Several other ingredients enter 
into their composition, yet their efficacy chiefly depends upon their 
predominating elements : the second class includes the bitter or 
purgative waters highly prized both in this country and abroad. 

Sulphuretted. — The sulphuretted hydrogen present in these 
waters lends to them their chief therapeutic value. They contain 
also various sulphides — of potassium, sodium, calcium, and mag- 
nesium — together with earthy and other sulphates, which doubtless 
contribute in a measure to their potency as physiological agents, 
although their action upon the system is still a matter of con- 
jecture. 



MINERAL WATERS. 



181 



Chalybeate. — Many mineral springs contain iron, yet in 
amounts so insignificant as to be of little value to therapy. There 
are, however, chalybeate waters highly charged with iron salts in 
the form of the carbonate or sulphate which have acquired a repu- 
tation for efficacy in the treatment of certain diseases. 

Acidulous. — The valuable property of these springs lies in the 
superabundance of carbonic-acid gas they contain, to which the 
solid constituents are subordinate, the carbon dioxide being the 
important therapeutic ingredient. 

Calcareous. — Calcium, in the form of the carbonate, is the 
valuable constituent of calcareous waters. Besides this substance 
they contain magnesium carbonate in varying quantities. Their 
utility as mineral waters has been questioned, many authorities 
refusing them recognition as therapeutic agents. 



The following enumeration 
able list compiled by Dr. A. N 

Alkaline : 
Adams, California. 
Albury, Vermont. 
Alma, Michigan. 
Alum, Virginia. 
Borax, California. 
Blount, Alabama. 
Berkshire, Vermont. 
Canon City, Colorado. 
Carlisle, Colorado. 
Congress, California. 
Elgin, Vermont. 
Fry's Soda, California. 
Highland, California. 
Highgate, Vermont. 
Lower Soda, California. 
Milford, New Hampshire. 
Manitou, Colorado. 
Middletown, Vermont. 
Napa Soda, California. 
Newbury, Vermont. 
Perry, Illinois. 
Rocky Mountain, Colorado. 
Ravenden, Arkansas. 
South Park, Colorado. 



of native springs is from the admir- 
Bell : 

Summit Soda, California. 
Seltzer, California. 
Sheldon, Vermont. 
Vichy, California. 
Wilholt Soda, California. 

Calcic : 

Bethesda, Wisconsin. 
Butterworth, Michigan. 
Birch-Dale, Vermont. 
Clarendon, Vermont. 
Eaton Rapid, Michigan. 
Gettysburg, Pennsylvania. 
Hubbardstown, Michigan. 
Silurian, Wisconsin. 

Chalybeate : 
Abbeville, South Carolina. 
Alma, Michigan. 
Bedford, Pennsylvania. 
Blossburg, Pennsylvania. 
Cooper's Well, Mississippi. 
Esbitt, Kentucky. 
Fayette, Pennsylvania. 
Gordon's, Georgia. 



182 



A TEXT-BOOK OF MATERIA MEDICA. 



Greencastle, Indiana. 
Kittrell's, North Carolina. 
Madison, Georgia. 
Manley, North Carolina. 
Milford, New Hampshire. 
Montvale, Tennessee. 
Owasso, Michigan. 
Rowland's, Georgia. 
Schooley's Mountain, New 

Jersey. 
Schuyler County, Illinois. 
Sparta, Wisconsin. 
Versailles, Indiana. 

Purgative Saline : 
Alma, Michigan. 
Blue Lick, Kentucky. 
Crab Orchard, Kentucky. 
Elgin, Vermont. 
Esculapian, Kentucky. 
Harrodsburg, Kentucky. 
Midland, Michigan. 
Pagosa, Colorado. 

Saline : 

Fruit-Port Well, Michigan. 
Grand Haven, Michigan. 
Louisville Artesian, Kentucky. 
Michigan Congress, Michigan. 
Mt. Clemens, Michigan. 
Ocean, Alabama. 
Salt, Virginia. 

Spring Lake Well, Michigan. 
St. Louis, Missouri. 

Sulphurous : 

Alpena, Michigan. 
Balston, New York. 
Bladon, Florida. 
Blue Lick, Kentucky. 
Carlisle, Pennsylvania. 
De Soto, Louisiana. 



Dremion, Kentucky. 
French Lick, Indiana. 
Glenn's, South Carolina. 
Highgate, Vermont. 
Indian, Georgia. 
Indian, Indiana. 
Lodi Artesian, Indiana. 
Manley, North Carolina. 
Minnequa, Pennsylvania. 
Montesano, Missouri. 
Olympian, Kentucky. 
Portea Springs, Colorado. 
Salt Sulphur, Virginia. 
Saratoga, New York. 
Sharon, New York. 
Sheldon, Vermont. 
Shocco, North Carolina. 
St. Helena White Sulphur, 

California. 
St. Louis, Michigan. 
Sweet, Missouri. 
Valhemosa, Alabama. 
West Baden, Indiana. 
White Sulphur, Louisiana. 
White Sulphur, Montana. 
White Sulphur, Virginia. 

Unclassified : 
Alum, Virginia. 
Birch-Dale, New Hampshire. 
Borax, California. 
Climax, Missouri. 
Eureka, Arkansas. 
Fairview, Texas. 
Greeneleone, Florida. 
Geysers, the American, Wyo- 
ming. 
Geyser Spa, California. 
Iodide and Bromide, Missouri, 
Piedmont, Texas. 
Stafford, Connecticut. 



BITTERS. 



183 



Summit, Maine. 
Sheldon, Vermont. 

Thermal Springs: 
Agua Caliente, New Mexico. 
Arrow-Head, California. 
Buncombe County, North 

Carolina. 
Calistoga, California. 
Chalk Creek Hot, Colorado. 
Charleston Artesian, South 

Carolina. 
Des Cahutes Hot, Oregon. 



Harbines, California. 
Hot Springs, Arkansas. 
Idaho Hot, Colorado. 
Merriweather, Georgia. 
Middle Park Hot, Colorado. 
Ojo Caliente, New Mexico. 
Paraiso, California. 
Passo Robles, California. 
Salt Lake, Utah. 
Seigler, California. 
Skaggs, California. 
Volcano, Nebraska. 
Warm and Hot, West Virginia. 



GROUP VII.— BITTERS. 

SIMPLE BITTERS. 

Quassia— Quassiae— Quassia. U. 8. B. 

Origin. — The wood of Picrcena excelsa Swz., a tree resembling 
the common ash, attaining a height of from 60 to 80 feet (18-24 
M.), indigenous in Jamaica. 

Description and Properties. — In the shops it is usually met 
with in the form of chips or raspings of a yellowish-white color. 
Quassia contains two bitter principles — quassin and picrasmin. It 
contains no tannin. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Official Preparations. 

Extr^ctum Quassiae — Extr&cti Quassiae — Extract of Quassia. — Dose, 1-3 
grains (0.065-0.2 Gm.). 

Extractum Quassiae Fluidum— Extracti Quassias Fluidi— Fluid Extract 
of Quassia. — Dose, 10-30 minims (0.6-2.0 Cc). 

Tinctura Quassiae — Tinctiirae Quassiae — Tincture of Quassia. — Dose, \-2. 
fluidrachms (2.0-7.3 Cc). 

Gentiana— Gentianae— Gentian. TJ. S. P. 

Origin. — The root of Gentiana lute a L., a plant from 2 to 3 feet 
high, indigenous in the mountainous portions of Central Europe. 

Description and Properties. — It appears in nearly cylindrical 
pieces or longitudinal slices about 1 inch (25 Mm.) thick, the upper 
portion closely annulate, the lower longitudinally wrinkled ; exter- 
nally deep yellowish-brown ; internally lighter ; somewhat flexible 



184 A TEXT-BOOK OF MATERIA MEDICA. 

and rather thick, separated from the subspongiose meditullium by 
a black cambium line. Odor peculiar, faint, stronger when moist- 
ened; taste sweetish and persistently bitter. Gentian contains a 
bitter glycoside, gentiopicrin, and also gentisic acid, to which its 
yellow color is due. It contains about 15 per cent, of glucose, but 
no starch or tannin. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparations. 

Extractum Gentianae— Extracti Gentianae— Extract of Gentian.— Dose, 2- 
10 grains (0.12-0.6 Gm.). 

Extractum Gentianae Fluidum— ExtrScti Gentianae Fluidi— Fluid Extract 
of Gentian. — Dose, 5-30 minims (0.3-2.0 Cc). 

Tinctura Gentianae Comp6sita— Tincturae Gentianae Comp6sitae— Com- 
pound Tincture of Gentian.— Dose, 1-2 nuidrachms (4.0-8.0 Cc). 10 per cent, 
with Orange Peel and Cardamom. 

Calumba— Calumbae— Calumba. 77. S. P. 

(COLUMBO.) 

Origin. — The root of Jateorhiza palmata, Lam., a plant native 
to the forests of Eastern Africa and Madagascar, and cultivated 
in the East Indies. 

Description and Properties. — Nearly circular disks 1 to 2 
inches (25-50 Mm.) in diameter and \ to \ inch (6-12 Mm.) thick. 
Externally greenish-brown and wrinkled ; internally yellowish or 
grayish-yellow ; depressed in the center, with a few interrupted cir- 
cles of projecting wood-bundles ; distinctly radiate in the outer por- 
tion; fracture short, mealy; odor slight; taste mucilaginous, slightly 
aromatic, very bitter. It contains a bitter crystalline principle, ca- 
lutnbin, calumbic acid, berberine, and starch. No tannin is present. 

Dose. — 10-60 grains (0.6-4.0 Gm.). 

Official Preparations. 

Extr3ctum Calumbae Fliiidum — Extraxti Caltimbae Fluidi— Fluid Extract 
of Calumba. — Dose, 10-60 minims (0.6-4.0 Cc). 

Tinctura Caltimbae — Tincturae Calumbae — Tincture of Calumba. — Dose, 1- 
4 fluidrachms (4.0-15. Cc). 

Calendula— Calendulae— Calendula. U. 8. JP. 

(Marigold.) 

Origin. — The florets of Calendula officinalis L., an annual plant, 
a native of the Levant and Europe, frequently cultivated as a 
garden ornament. 



BITTERS. 185 

Description and Properties. — Florets about \ inch (12 Mm.) 
long, linear and strap-shaped, delicately veined longitudinally, 
yellow or orange-colored, three-toothed at the apex, the short, 
hairy tube enclosing the remnants of a filiform style elongately 
cleft. Odor slight and somewhat heavy ; taste rather bitter and 
faintly saline. It contains a peculiar gummy principle, calendulin, 
a bitter constituent, and a trace of volatile oil. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparation. 

Tinctura Calendulae — Tincturae Calendulae— Tincture of Calendula. — Dose, 
15-60 minims (1.0-4.0 Cc). 

Unofficial Preparation. 
Extractum Calendulae Fluidurn — Extr^cti Calendulae Fluidi — Fluid Ex- 
tract of Calendula. — Dose, 5-30 minims (0.3-2.0 Cc). 

Chirata— Chiratae— Chirata. 77. 8. P. 

Origin. — The entire plant, Swertia chirata Hamilton, an annual, 
native to Northern India. 

Description and Properties. — Chirata as found in the shops 
consists of short sections of the stem and branches pressed and 
split, brown or dark-purple in color, and mixed with a few leaves 
and flowers. It contains a very bitter yellow principle, a hygro- 
scopic glycoside chiratin, a bitter syrupy liquid, ophelic acid, a resin, 
coloring matter, etc. No tannin is present. 

Dose. — 5-20 grains (0.3-1.3 Gm.). 

Official Preparations. 

Extractum Chiratae Fluidurn— Extretcti Chiratae Fluidi — Fluid Extract of 
Chirata. — Dose, 5-20 minims (0.3-1.3 Cc). 

Tinctura Chiratae — Tincturae Chiratae — Tincture of Chirata. — Dose, l / 2 -\ 
fluidrachm (2.0-4.0 Cc). 

AROMATIC BITTERS. 

Anthemis— Anthemidis— Anthemis. TJ. S. P. 

(Chamomile.) 

Origin. — The flower-heads of Anthemis nobilis L., a low peren- 
nial plant indigenous in Southern and Western Europe. 

Description and Properties. — Heads subglobular, about f inch 
(2 Cm.) broad, consisting of an imbricated involucre and numerous 
white, strap-shaped, three-toothed florets, and a few, if any, yellow 



1 86 A TEXT-BOOK OF MATERIA MEDICA. 

tubular disk-florets, inserted upon a chaffy, conical, solid receptacle ; 
of a strong, agreeable odor and an aromatic, bitter taste. Anthemis, 
contains a bitter principle, a pale-blue or yellowish-brown volatile- 
oil, and a trace of tannin, together with other unimportant con- 
stituents. 

Dose. — 15-60 grains (1.0-4.0 Gm.), in infusion or fluid extract. 

Cascarilla— CascarWae— Cascarilla. XT. S. JP. 

Origin. — The bark of Croton Eluteria, Bennett, a small shrub 
indigenous in the Bahama Islands. 

Description and Properties. — Quills or curved pieces about -^ 
inch (2 Mm.) thick, having a grayish, somewhat fissured, easily 
detached, corky layer, more or less coated with a white lichen, the 
uncoated surface being dull brown, the inner surface being smooth. 
The bark breaks with a short fracture, having a resinous and 
radially striate appearance. When burned it emits a strong, aro- 
matic, somewhat musk-like odor ; taste warm and very bitter. It 
contains a volatile oil, a bitter, crystalline principle, cascarillin, tannin, 
resin, etc. 

Dose. — 10-30 grains (0.6-2.0 Gm.), or 10-30 minims (0.6-2.0 
Cc.) of the fluid extract. 

Prunus Virginiana— PrGni Virginianae— Wild 
Cherry. U. S. JP. 

Origin. — The bark, collected in autumn, of Prunus serotina 
Ehr, a large forest tree indigenous in North America. 

Description and Properties. — It is met with in curved pieces 
or irregular fragments -^ inch (2 Mm.) or more thick ; outer 
surface greenish-brown or yellowish-brown, smooth and somewhat 
glossy, marked with transverse scars. If the bark is collected from 
the old wood and deprived of the corky layer, the outer surface is 
nut-brown and uneven ; inner surface somewhat striate or fissured. 
Upon maceration in water it develops a distinct bitter-almond odor. 
Taste astringent, aromatic, and bitter. It contains tannin, resin, a 
glycoside amygdalin (laurocerasin), and a ferment, emulsin. In 
the presence of water the glycoside is broken up into hydrocyanic 
acid and a volatile oil. Benzaldehyd results also from the ferment 
action. Temperature above 160 F. destroys the action of the 
ferment. 

Dose. — J- 1 drachm (2.0-4.0 Gm.). 



BITTERS. 187 

Official Preparations. 

Extractum Pruni Virginianse Fluidum — Extralcti Pruni Virginianse Fluidi 
— Fluid Extract of Wild Cherry. — Dose, 30-60 minims (2.0-4.0 Cc). 

Infusum Pruni Virginianse — Infusi Pruni Virginianse— Infusion of Wild 
Cherry. — Dose, 1-2 fluidounces (30.0-60.0 Cc). 

Syrupus Pruni Virginianse— Syrupi Pruni Virginianse— Syrup of Wild 
Cherry. — Dose, 2-4 fluidrachms (8.0-15. Cc.). 

Serpentaria— Serpentariae— Serpentaria. V. S. JP. 

(Virginia Snake-root.) 

Origin. — The rhizome and roots of Aristolochia serpentaria L., 
and of Aristolochia reticulata Nutt, perennial herbs indigenous in 
the United States. 

Description and Properties. — The rhizome is about 1 inch (25 
Mm.) long, thin, curved; on the upper side with approximate, 
short stem-bases ; on the lower side with numerous thin, branching 
roots about 4 inches (10 Cm.) long; dull yellowish-brown, inter- 
nally whitish ; the wood-rays of the rhizome are longest on the 
lower side ; odor aromatic, camphoraceous ; taste warm, bitterish, 
and camphoraceous. It contains \ per cent, of volatile oil, a bitterish 
principle, aristolochine, tannin, resin, starch, etc. The roots of 
Aristolochia reticulata are coarser, longer, and less interlaced than 
those of Aristolochia serpentaria. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Official Preparations. 

Extraxtum Serpentariae Fluidum— ExtrScti Serpentariae Fluidi— Fluid 
Extract of Serpentaria. — Dose, 10-30 minims (0.6-2.0 Cc). 

Tinctura Cinchonse Composita — Tincturse Cinchonse Comp6sitse — Com- 
pound Tincture of Cinchona. — Dose, 1-4 fluidrachms (4.0-15. Cc.) (2 per cent, 
of serpentaria.) 

Tinctura Serpentariae — Tincturse Serpentariae — Tincture of Serpentaria. — 
Dose, \-2 fluidrachms (2.0-8.0 Cc). 



Antagonists and Incompatibles. — The salts of iron, lead, and 
silver are incompatible with gentian and the aromatic bitters, though 
preparations of iron can be given with quassia, calumba, and 
chirata. Boiling water impairs the virtues of wild cherry. 

Synergists. — The digestants, mineral acids, and, under certain 
conditions, alkalies, and the restorative agents generally, aid the 
action of vegetable bitters. 

Physiological Action. — Because of their action in augmenting 



i88 



A TEXT-BOOK OF MATERIA MEDICA. 



the secretions from the salivary and gastric glands, aiding diges- 
tion and improving nutrition, Vegetable Bitters are classed among 
Restoratives. By increasing the activity of the various glands they 
aid digestion, and by their effect upon the nerves they stimulate the 
appetite. 

Pure bitters act immediately upon contact; that is, their 
efficiency is due to their local action upon the mucous membrane 
of the gastro-intestinal tract, with which they are brought into 
direct contact. There are certain drugs, however — such as cin- 
chona, nux vomica, etc. — which act also upon the blood or remote 
parts of the system. When used as bitters we are concerned only 
with the local action of these agents. 

I. Bitters increase the secretion from the salivary glands. This 
effect is produced by stimulating the ends of the nerves of taste 

distributed in the mucous membrane of 
the mouth, from which nerves the im- 
pression is conveyed to the center in the 
medulla, and from there transmitted to 
the vaso-motor and secretory nerves sup- 
plying the salivary glands, increasing their 
blood-supply and activity, and at once 
promoting the secretion of saliva. Were 
salivary secretion stimulated by the drug 
entering the circulation, and through the 
blood exciting the medulla and the glands, 
a much longer time would elapse before 
an increased flow of saliva would be pro- 
duced. It is therefore certain that the 
rapid reflex excitation of the glands, and 
consequent immediate increase in the sal- 
ivary secretion, are due to direct contact 
with the nerve-endings in the mucous 

membrane of the mouth. The accompanying diagram (Fig. i) 

will serve to elucidate the action named. 

II. Bitters increase the secretion from the gastric glands. The 
primary action is an augmented flow of gastric juice, caused by 
reflex stimulation from the mouth. It is well known that there 
is an intimate relationship between the stomach and the senses of 
taste and smell. The taste of victuals or the odor of a tempting 
dinner excites the appetite, and, reflexly, the flow of gastric juice, 
similar to the flow of saliva in a dog looking wistfully at a meat- 
stand. Bitters act in a similar manner. The nerves of taste are stimu- 




Fig. i. — Diagram illustrating the 
action of bitters on the salivary 
glands: i, nerve conveying the 
impression from the mucous mem- 
brane of the mouth (C) to the me- 
dulla (A) ; 2, secretory nerve trans- 
mitting the impression from the 
medulla (A) to the salivary gland 
(B); 3, duct of the salivary gland. 



BITTERS. 



lated ; the impression is conveyed to the medulla, and from it trans- 
mitted not only to the salivary glands, but through the fibers of 
the vagus, increasing the blood-supply to the gastric glands and 
thereby promoting their functional activity. 

When the bitters have been swallowed, an increased secretion 
ensues, occasioned by direct stimulation of the mucous mem- 
brane of the stomach. Through the sen- 
sory fibers of the vagus the impression is 
conveyed to the center in the medulla, 
returning by the vaso-motor and secretory 
fibers, and increasing the functional activity 
of the glands. This action is well shown 
in the diagram (Fig. 2). 

When too large a dose of bitters has 
been taken, or under prolonged medicinal 
dosage — when contraindicated by an irri- 
table stomach — the effects are a diminished 
secretion of gastric juice and a corre- 
sponding increase in the secretion of mucus. 
This effect of over-stimulation or irritation 
is well illustrated in persons addicted to the 
excessive use of alcohol, a moderate amount 
promoting the secretion of gastric juice and 
improving the appetite, while excess occa- 
sions nausea and the vomiting of glairy 
mucus. 

The theory governing the above action 
is that a medicinal dose of bitters is just 
sufficient to stimulate the functional activity 
of the gastric glands, but that immoderate 
or continuous dosage tends to convey the impression farther up in 
the medulla, causing stimulation of the vaso-constrictor fibers, con- 
tracting the blood-vessels, and lessening the blood-supply and the 
secretion from the glands. At the same time the secretory fibers 
supplying the mucous cells are stimulated, causing an increased 
secretion of mucus. Should the dose be sufficiently large to pro- 
duce vomiting, the action is due to the fact that the impression is 
conveyed still higher in the medulla, and from there transmitted 
to the nerves supplying the abdominal walls and diaphragm, the 
effect being to produce emesis. The diagram (Fig. 3) graphically 
illustrates this action. 

III. Bitters stimulate the peristaltic movements of the stomach 




Fig. 2. — Diagram illustrating 
the action of bitters on the gas- 
tric secretion: A, medulla; B, 
stomach ; C, gland ; D,D, blood- 
vessels supplying the gland ; E, 
nerves of taste; i, vaso-motor 
fibers ; 2, secretory fibers ; 3, sen- 
sory fibers. 



190 



A TEXT-BOOK OF MA TERIA MEDICA. 



by reflex action. The sensory nerves in the mucous membrane are 
irritated, and an impression is conveyed by them to Auerbach's 
plexus between the muscles in the walls of the stomach, from 
which plexus, or ganglion, the influence is transmitted to the mus- 
cles themselves, causing increased activity or peristalsis. 

Another method by which peristalsis is stimulated occurs when 
the impression is conveyed by the sensory nerves directly to the 
center in the medulla, and from there through the motor fibers of 
the vagus to Auerbach's plexus, affecting the muscles in the man- 
ner above described. The cut (Fig. 4) will serve to illustrate the 
modus operandi. 




Fig 3. — Diagram illustrating the supposed nervous connections of the stomach. A gentle stimulus 
applied to the walls of the stomach is transmitted by the afferent nerves (A) to a nerve-center (B), 
and thence along the vaso-dilating nerves (C) and the secreting nerves (Z>) to the vessels of the mucous 
membrane and the cells of the gastric follicles. A stronger stimulus is transmitted up to the nerve- 
center (£), and thence along the vaso-constricting fibers (F) and the secreting fibers (G) of the mu- 
cous follicles. A still stronger stimulus is transmitted to H, and thence along the motor nerves to the 
abdominal walls {K, K), causing them to contract and produce retching or vomiting. 



IV. Bitters augment absorption by increasing the blood-supply 
to the mucous membrane of the stomach. It is a physiological 
fact that the larger the blood-supply passing through the blood- 
vessels, and the greater the amount of lymph conveyed through 
the lymph-channels, the more rapid the absorption. 

V. Bitters also induce leucocytosis. Their action as antiseptics 
is secondary to the increase of the gastric juice, digestion being a 



BITTERS. 



191 



physiological fermentative process, forming a contraindication to 
the administration of bitters during active digestion. 

Therapeutics. — Externally and Locally. — Calendula, in the 
form of a poultice, is an efficient and grateful application as a dress- 
ing to cancer of the breast. The tincture 
of calendula is recommended by many phy- 
sicians as an external application for contu- 
sions, sprains, etc., although not so efficient 
as tincture of arnica. The drug has been 
used topically in chronic pharyngitis and 
suppurative inflammation of the ear. 

Internally. — The simple bitters are pecu- 
liarly useful in atonic and fermentative dys- 
pepsia, chronic gastric catarrh, and as a tonic 
in convalescence from acute disease, in mala- 
rial fever, and in the anorexia following it. 
Infusion of quassia is a most efficacious 
injection to destroy seat-worms {Oxyuris ver- 
micularis), the infusion being injected into 
the rectum, which has been previously 
washed out with soap and water and 
cleared of mucus by salines. 

The aromatic bitters are used to stimu- 
late the appetite and improve the condition 
of the digestive apparatus. The simple bit- 
ters are similarly used, but the former pos- 
sess more stimulating and tonic properties, 
owing to their volatile and astringent con- 
stituents. Chamomile, in addition to its action as a stimulant to 
the digestion, has been employed with benefit in delirium tremens 
and as an emmenagogue, while in the form of hot poultices chamo- 
mile flowers serve as an efficient application for local pains. 

Wild cherry might not inaptly be called a sedative tonic, its 
peculiarly bitter yet not unpleasant taste causing it to be well toler- 
ated by the stomach, and rendering it one of the best stomachic 
tonics, especially during convalescence, when its sedative action 
upon the heart allays febrile and cardiac excitement. The syrup 
of wild cherry is a common ingredient of " cough-syrups." It is 
thought to quiet the cough and allay the irritability of the nervous 
system in bronchitis and phthisis, — probably owing to the hydro- 
cyanic acid which it contains. 

Serpentaria is considered an efficient expectorant \n pneumonia 




Fig. 4. — Diagram illustrating 
the action of bitters upon peri- 
stalsis : A, medulla; B, stom- 
ach ; C, Auerbach's plexus ; D, 
mucous membrane ; E, muscles ; 
1, motor fibers ; 2, sensory fibers. 



192 A TEXT-BOOK OF MATERIA MEDICA. 

and capillary bronchitis. Next to its use as a stomachic its chief 
value seems to be as a stimulant in typhus and typhoid fevers, the 
compound tincture of cinchona being a most excellent remedy in 
the low forms of typhoid. The fluid extract of serpentaria is con- 
sidered somewhat of a sexual stimulant. It has been used with 
some success in poisoning by Rhus toxicodendron. 

Contraindications. — I. Bitters should not be given when the 
secretion of gastric juice is diminished as the result of organic 
disease. 2. They are contraindicated as stomachics during the 
course of acute disease, as in fevers. 3. When, after a reasonable 
time, they fail to improve the appetite, they should be discontinued. 
4. In convalescence from acute disease, when the appetite is vora- 
cious, they are contraindicated. 5. In catarrhal conditions of the mu- 
cous membrane of the stomach — as in chronic gastritis and " drunk- 
ards' catarrh of the stomach " — alcoholic preparations of bitters, 
tinctures, etc. should not be administered, aqueous preparations 
only, like infusions, being permissible. 6. Should the digestion be 
impaired and the appetite good, it is an indication that the indiges- 
tion is intestinal, and therefore beyond the influence of bitters. 

Administration. — To improve the appetite bitters should be 
given from one-half to one hour before meals. When necessary to 
use them for a long time, one bitter should be substituted for 
another in the course of every week or two ; otherwise the stomach 
may rebel at the monotony. Bitters may be given in the form of 
a powder or a solid extract. Ordinarily, however, it is preferable to 
administer a liquid preparation — fluid extract, tincture, or infusion. 
A pleasant method of giving the latter preparation in the case of 
quassia is to allow water to stand over-night or for a few hours in 
a quassia-cup — purchasable at almost any drug-store — when the 
water will become impregnated with the bitter principle of the 
quassia. 

GROUP VIII.— HEMATICS. 

PREPARATIONS OF IRON. 

Ferrum Reductum— Ferri Reducti— Reduced Iron. 

JJ. S. I*. 

(Iron by Hydrogen; Quevenne's Iron.) 

Origin. — Obtained by passing Hydrogen through a hot closed 
tube containing freshly prepared and thoroughly washed Ferric 
Oxide. 



HEMATICS. 193 

Description and Properties. — A very fine, grayish-black, lustre- 
less powder, odorless and tasteless ; permanent in dry air ; insolu- 
ble in water or alcohol. 

Dose. — 1-5 grains (0.5-0.3 Gm.). 

Ferri Carbonas Saccharatus — Ferri Carbonatis 
Saccharati — Saccharated Ferrous Carbonate. 
U. S. I>. 

Origin. — Prepared from Ferrous Sulphate, Sodium Bicarbonate, 
Sugar, and Distilled Water, by solution and filtration. 

Description and Properties. — A greenish-brown powder grad- 
ually becoming oxidized by contact with air ; without odor, and 
having at first a sweetish, afterward a slightly ferruginous, taste. 
Only partly soluble in water, but completely soluble in hydro- 
chloric acid, with copious evolution of carbonic-acid gas, forming a 
clear, greenish-yellow liquid. The product should be kept in small, 
well-stoppered bottles. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Massa Ferri Carbonatis— Massae Ferri Carbonatis 
—Mass of Ferrous Carbonate. U.S.I*. 

(Vallet's Mass.) 

Origin. — Prepared by solution, filtration, and evaporation from 
Ferrous Sulphate, Sodium Carbonate, Clarified Honey, Sugar, 
Syrup, and Distilled Water. 

Description and Properties. — When recently prepared the 
mass is of a greenish-gray color, but on exposure it becomes 
greenish-black. 

Dose. — 3-5 grains (0.15-0.3 Gm.). 

MistGra Ferri Composita — Misturae Ferri Com- 
positae— Compound Iron Mixture. U.S.I*. 

(Griffith's Mixture.) 

Origin. — Prepared by mixing Ferrous Sulphate, Myrrh, Sugar, 
Potassium Carbonate, Spirit of Lavender, and Rose Water. 

Description and Properties. — When newly prepared it is of 
a dirty greenish color, but slowly oxidizes on exposure to the air, 
and should therefore be freshly prepared when needed. 

Dose. — l-il ounces (1 5.-45 Cc). 
13 



194 A TEXT-BOOK OF MATERIA MEDICA. 

FerrModidum Saccharatum— Ferri Iodidi Saccha- 
rati— Saccharated Ferrous Iodide. JJ. S. I>. 

Origin. — Prepared by solution, nitration, evaporation, and tritu- 
ration from Iron Wire, Reduced Iron, Iodine, Distilled Water, and 
Sugar of Milk. 

Description and Properties. — A yellowish-white or grayish, 
hygroscopic, odorless powder, having a sweetish, ferruginous taste. 
Soluble in 7 parts of water, but only partially soluble in alcohol. 
It should be kept in a cool, dark place, in small, perfectly dry, 
securely-stoppered bottles. 

Dose. — 5-10 grains (0.3-0.6 Gm.). 

PTlulae Ferri Iodidi— Pilulas (ace.) Ferri Iodidi— Pills 
of Ferrous Iodide. U.S.I*. 

Origin. — Pills made of Reduced Iron, Iodine, Glycyrrhiza, Sugar, 
Extract of Glycyrrhiza, Acacia, Balsam of Tolu, Water, and Ether, 
evaporated to pilular consistence. 

Description and Properties. — These preparations are very un- 
stable, and should be kept from the light as much as possible. 

Dose. — One to two pills, each pill containing nearly 1 grain 
(0.061 Gm.) of ferrous iodide. 

Syrupus Ferri Iodidi— Syrupi Ferri Iodidi— Syrup of 
Ferrous Iodide. V. S. JP. 

Origin. — A syrup containing 10 per cent, of Ferrous Iodide. 
Description and Properties. — A transparent, pale-green liquid, 
having a sweet, strongly ferruginous taste and a neutral reaction. 
Dose. — 5-30 minims (0.3-2.0 Cc). 

Ferri Chloridum— Ferri Chloridi— Ferric Chloride. 

Origin. — Prepared by the action of Hydrochloric Acid and 
Distilled Water upon Iron Wire, subsequent filtration, addition of 
Nitric Acid, and crystallization. 

Description and Properties. — Orange-yellow, crystalline pieces, 
odorless or having a faint odor of hydrochloric acid, and a strongly 
styptic taste ; very deliquescent in moist air ; freely and completely 
soluble in water or alcohol, also in a mixture of I part of ether 
and 3 parts of alcohol. Ferric chloride should be kept in glass- 
stoppered bottles protected from light. 

Dose. — It is chiefly used topically, as an astringent and hemo- 
static. 



HE MA TICS. 195 

Liquor Ferri Chloridi— Liquoris Ferri Chloridi— 
Solution of Ferric Chloride. U. S. P. 

Origin. — An aqueous solution of Ferric Chloride (Fe 2 Cl 6 = 
323.98), containing about 37.8 per cent, of the anhydrous salt, 
corresponding to 62.9 per cent, of the crystallized salt, or about 
13 per cent, of metallic iron. 

Description and Properties. — A reddish-brown liquid, having 
a faint odor of hydrochloric acid, an acid, strongly styptic taste, 
and an acid reaction. 

Dose. — 2-10 minims (0.12-0.6 Cc), largely diluted. 

Tinctura Ferri Chloridi— Tincturae Ferri Chloridi— 
Tincture of Ferric Chloride. U. S. P. 

Origin. — A hydro-alcoholic solution of Ferric Chloride, con- 
taining about 13.6 per cent, of the anhydrous salt, corresponding 
to about 4.7 per cent, of metallic iron. 

Description and Properties. — A bright, brownish liquid having 
a slightly ethereal odor, a very astringent, styptic taste, and an acid 
reaction. 

Dose. — 5-30 minims (0.3-2.0 Cc). 

Liquor Ferri Acetatis— Liquoris Ferri Acetatis— 
Solution of Ferric Acetate. IT. S. P. 

Origin. — An aqueous solution of Ferric Acetate, containing 
about 31 per cent, of the anhydrous salt, corresponding to about 
7.5 per cent, of metallic iron. 

Description and Properties. — A dark, reddish-brown, clear 
liquid, of an acetous odor, a sweetish, acidulous, somewhat styptic 
taste, and a slightly acid reaction. 

Dose. — 1-8 minims (0.06-0.5 Cc). 

Liquor Ferri et Ammonii Acetatis— Liquoris Ferri 
et Ammonii Acetatis— Solution of Iron and 
Ammonium Acetate. U. S. P. 

(Basham's Mixture.) 

Formula. — Prepared with Tincture of Ferric Chloride, 20 parts ; 
Diluted Acetic Acid, 30 ; Solution of Ammonium Acetate, 200 ; 
Aromatic Elixir, 100; Glycerin, 120; Water, to 1000. 

Dose. — 1-4 fluidrachms (4.0-15.0 Cc). 

Ferri Citras— Ferri Citratis— Ferric Citrate. U.S. P. 

Origin. — Prepared by evaporating solution of Ferric Citrate on 
a water-bath at a temperature not exceeding 6o° C. (140 F.). 



196 A TEXT-BOOK OF MATERIA MEDIC A. 

Description and Properties. — Thin, transparent, garnet-red 
scales, without odor and having a slightly ferruginous taste. 
Slowly but completely soluble in cold water, and readily soluble 
in hot water, but diminishing in solubility with age. Insoluble in 
alcohol. Ferric citrate should be kept in well-stoppered bottles, 
protected from light. 

Dose. — 5-20 grains (0.3-1.20 Gm.), in solution. 

Liquor Ferri Citratis— Liquoris Ferri Citratis— 
Solution of Ferric Citrate. TJ. S. 2*. 

Origin. — Prepared by precipitating a solution of Ferric Sulphate 
in Water with Ammonia Water, adding Citric Acid, filtering, and 
evaporating the filtrate to the proper amount. 

Description and Properties. — A dark-brown liquid, odorless, 
of an acid reaction, and possessing a slightly ferruginous taste. 

Dose. — 5-15 minims (0.3-1.0 Cc). 

Vinum Ferri Citratis— VIni Ferri Citratis— Wine of 
Ferric Citrate. U. S. JP. 

Composition. — Iron and Ammonium Citrate, Tincture of Sweet 
Orange Peel, Syrup, and Water. 

Dose. — J-i fluidrachm (2.0-4.0 Cc). 

Ferri et Ammonii Citras— Ferri et Ammonii Citratis 
—Iron and Ammonium Citrate. U. S. JP. 

Origin. — Prepared by evaporating a solution of Ferric Citrate 
and Ammonia Water. 

Description and Properties. — Thin, transparent, garnet-red 
scales, odorless, and having a saline, mildly ferruginous taste ; 
deliquescent in moist air. Completely soluble in water, but 
insoluble in alcohol. 

Dose. — 5-10 grains (0.3-0.6 Gm.). 

Ferri et Quinlnae Citras— Ferri et QuinTnae Citratis 
—Iron and Quinine Citrate. U. S. I*. 

Origin. — Solution of Ferric Citrate in Distilled Water and 
solution of Quinine and Citric Acid in Distilled Water are mixed, 
evaporated on a water-bath to the consistence of syrup, and dried 
on plates of glass. 

Description and Properties. — Thin, transparent scales, of a 






HEMATICS. 197 

reddish-brown color, without odor, and having a bitter, mildly 
ferruginous taste ; slowly deliquescent in damp air. Gradually but 
completely soluble in cold water, more readily soluble in hot water, 
and but partially soluble in alcohol, its solubility diminishing with 
age. It should be kept in well-stoppered bottles, protected from 
light 

Dose. — 2-10 grains (0.12-0.6 Gm.). 



Ferri et Quinlnae Citras Solubilis— Ferri et Quininae 
Citratis Solubilis— Soluble Iron and Quinine 
Citrate. U. S. JP. 

Origin. — Prepared in the same manner as the above salt, but 
with the addition of Ammonia Water. 

Description and Properties. — Thin, transparent scales, of a 
greenish, golden-yellow color, odorless, and having a bitter, mildly 
ferruginous taste ; deliquescent in damp air. Rapidly and com- 
pletely soluble in cold water, but only partially soluble in alcohol. 
It should be kept in well-stoppered bottles, protected from light. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Ferri et StrychnTnae Citras— Ferri et Strychnlnae 
Citratis— Iron and Strychnine Citrate. TJ. S. P. 

Origin. — Solution of Iron and Ammonium Citrate in Distilled 
Water and solution of Strychnine and Citric Acid in Distilled 
Water are mixed, evaporated to the consistence of syrup by means 
of a water-bath, and dried on plates of glass. 

Description and Properties. — Thin, transparent scales, varying 
in color from garnet-red to yellowish-brown, without odor, and 
having a bitter, slightly ferruginous taste ; deliquescent in damp 
air. Readily and completely soluble in water, but only partly sol- 
uble in alcohol. It should be kept in well-stoppered bottles, pro- 
tected from light. 

Dose. — 1-3 grains (0.06-0.18 Gm.). 

VInum Ferri Amarum— Vini Ferri Amari— Bitter 
Wine of Iron. U. S. JP. 

Composition. — Soluble Iron and Quinine Citrate, Tincture of 
Sweet Orange Peel, Syrup, White Wine. 
Dose. — 1-2 fluidrachms (4.0-8.0 Cc). 



198 A TEXT-BOOK OF MA TERIA MEDICA. 

Syrupus Ferri, Quinlnae, et Strychnlnae Phospha- 
tum— Syrupi Ferri, Quinlnae, et Strychnlnae 
Phosphatum— Syrup of the Phosphates of Iron, 
Quinine, and Strychnine. U.S.I*. 

Dose. — 1-2 fluidrachms (4.0-8.0 Cc). 



Ferri Lactas— Ferri Lactatis— Ferrous Lactate. 

U. S. P. 

Description and Properties.— Pale, greenish-white crusts, con- 
sisting of small, needle-shaped crystals, having a slight, peculiar 
odor, and a mild, sweetish, ferruginous taste. Slowly but com- 
pletely soluble in 40 parts of water and in 12 parts of boiling 
water; almost insoluble in alcohol. Ferrous lactate should be 
kept in well-stoppered bottles. 

Dose. — 1-3 grains (0.06-0.2 Gm.). 

Syrupus Hypophosphltum cum Ferro— Syrupi Hy- 
pophosphltum cum Ferro— Syrup of Hypophos- 
phites with Iron. U. S. I*. 

Ferrous Lactate and Potassium Citrate dissolved in Syrup of 
Hypophosphites. 

Dose. — |-i fluidrachm (2.0-4.0 Cc). 

Ferri Oxidum Hydratum— Ferri Oxidi Hydrati— 
Ferric Hydrate. U.S.I*. 

(Ferric Hydroxide — Hydrated Oxide of Iron.) 

Origin. — To a solution of Ammonia Water in Water is added a 
solution of Ferric Sulphate in Water, and the precipitate collected. 

Description and Properties. — A brownish-red magma, wholly 
soluble in hydrochloric acid, without effervescence. 

Dose. — 4 drachms (16 Gm.), or ad libitum in case of arsenical 
poisoning. 

Ferri Oxidum Hydratum cum Magnesia — Ferri 
Oxidi Hydrati cum Magnesia— Ferric Hydrate 
with Magnesia. U. S. JP. 

Solution of Ferric Sulphate, Magnesia, and Water. 
Dose. — Amounts as necessary ad libitum. 



HEM A TICS. 



199 






Ferri et Ammonii Sulphas— Ferri et Ammonii Sul- 
phatis— Ferric Ammonium Sulphate. U. S. JP. 

(Ammonio-ferric Sulphate — Ammonio-ferric Alum.) 
Origin. — The crystals formed by adding Ammonium Sulphate 
to a boiling-hot solution of Ferric Sulphate. 

Description and Properties. — Pale violet, octahedral crystals, 
odorless, and having an acid, styptic taste ; efflorescent on exposure 
to the air. Soluble in 3 parts of water and in 0.8 part of boiling 
water; insoluble in alcohol. The product should be kept in well- 
stoppered bottles. 

Dose. — 5-15 grains (0.5-1.0 Gm.). 

Ferri et Ammonii Tartras— Ferri et Ammonii Tar- 
tratis— Iron and Ammonium Tartrate. U. 8. JP. 

(Ammonio-ferric Tartrate.) 

Description and Properties. — Thin, transparent scales, varying 
in color from garnet-red to reddish-brown, without odor, and 
having a sweetish, slightly ferruginous taste ; slightly deliquescent 
in the air. Very soluble in water; insoluble in alcohol. Iron and 
ammonium tartrate should be kept in well-stoppered bottles, pro- 
tected from light. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Ferri et Potassii Tartras— Ferri et Potassii Tar- 
tratis— Iron and Potassium Tartrate. TJ. 8. JP. 

(POTASSIO-FERRIC TARTRATE.) 

Description and Properties. — Thin, transparent scales, vary- 
ing in color from garnet-red to reddish-brown, without odor, and 
having a sweetish, slightly ferruginous taste ; slightly deliquescent 
in the air. Very soluble in water ; insoluble in alcohol. It should 
be kept in well-stoppered bottles, protected from light. 

Dose. — 5-20 grains (0.3-1.2 Gm.). 

Ferri Phosphas Solubilis— Ferri Phosphatis Solu- 
bilis— Soluble Ferric Phosphate. TJ. 8. JP. 
Description and Properties. — Thin, bright-green, transparent 
scales, odorless, and having an acidulous, slightly saline taste. The 
salt is permanent in dry air when excluded from light, becoming 
dark and discolored when exposed to it. Freely and completely 



200 A TEXT-BOOK OF MATERIA MEDICA. 

soluble in water, but insoluble in alcohol. It should be kept in 
dark amber-colored, well-stoppered bottles. 
Dose. — 5-10 grains (0.3-0.6 Gm.). 



Ferri Pyrophosphas Solubilis— Ferri Pyrophospha- 
tis Solubilis— Soluble Ferric Pyrophosphate. 

JI. S. I>. 

Description and Properties. — Thin apple-green, transparent 
scales, without odor, and having an acidulous, slightly saline taste ; 
permanent in dry air if protected from light, and if exposed to it 
becoming dark and discolored. Freely and completely soluble in 
water, but insoluble in alcohol. It should be kept in dark amber- 
colored, well-stoppered bottles. 

Dose. — 2-5 grains (0.1-0.3 Gm.). 



Ferri Hypophosphis— Ferri Hypophosphitis— Ferric 
Hypophosphite. U. S. JP. 

Origin. — The precipitate formed by mixing solutions of Sodium 
Hypophosphites and Ferric Chloride or Ferric Sulphate. 

Description and Properties. — A white or grayish-white pow- 
der, odorless and nearly tasteless, permanent in the air. Only 
slightly soluble in water. It should be kept in well-stoppered 
bottles. 

Dose. — 5-10 grains (0.3-0.6 Gm.). 



Ferri Valerianas— Ferri Valerianatis— Ferric 
Valerianate. V. S. JP. 

Origin. — The precipitate obtained by adding to a cold solution 
of Ferric Sulphate or Ferric Chloride a cold solution of Sodium 
Valerianate. 

Description and Properties. — A dark, brick-red, amorphous 
powder, of somewhat varying chemical composition, having the 
odor of valerianic acid and a mildly styptic taste ; permanent in 
dry air. Insoluble in cold water, but readily soluble in alcohol. 
Boiling water decomposes it, setting free the valerianic acid and 
leaving ferric hydrate. It should be kept in small, well-stoppered 
bottles, in a cool, dark place. 

Dose. — 1-3 grains (0.06-0.18 Gm.). 






HEM A TICS. 20I 

Ferri Sulphas— Ferri Sulphatis— Ferrous Sulphate. 

U. S. P. 

Origin. — Obtained by the action of Sulphuric Acid and Water 
upon Iron Wire. 

Description and Properties. — Large, pale bluish-green mono- 
clinic prisms, without odor, and having a saline, styptic taste; 
efflorescent in dry air ; on exposure to moist air the crystals rap- 
idly absorb oxygen, becoming coated with a brownish-yellow, 
basic ferric sulphate. Soluble in 1.8 parts of water and in 0.3 part 
of boiling water ; insoluble in alcohol. 

Dose. — 1-3 grains (0.06-0.18 Gm.). 



Ferri Sulphas Exsiccatus— Ferri Sulphatis Exsic- 
cati— Dried Ferrous Sulphate. U. S. P. 

Description and Properties. — A grayish-white powder, slowly 
but completely soluble in water. 

Dose. — |— 2 grains (0.03-0.12 Gm.). 



Ferri Sulphas Granulatus— Ferri Sulphatis Granu- 
lati— Granulated Ferrous Sulphate. U. S. P. 

Description and Properties. — A pale bluish-green, crystallized 
powder, which should conform in every respect to the reactions 
and tests given under Ferri Sulphas in the U. S. P. 

Dose. — -J-3 grains (0.03-0.18 Gm.). 



Liquor Ferri Subsulphatis— Liquoris Ferri Subsul- 
phatis— Solution of Ferric Subsulphate. TJ. S. P. 

(Solution of Basic Ferric Sulphate — Monsel's Solution.) 

Origin. — An aqueous solution of basic Ferric Sulphate — of 
varying chemical composition — corresponding to about 13.6 per 
cent, of metallic iron. 

Description and Properties. — A dark, reddish-brown liquid, 
odorless or nearly so, of an acid, strongly styptic taste, and an 
acid reaction. Miscible with water and alcohol in all proportions, 
without decomposition. 

Dose. — 1-10 minims (0.06-0.6 Cc), largely diluted — chiefly 
used, however, as a local styptic. 



202 A TEXT-BOOK OF MATERIA MEDICA. 

Liquor Ferri Tersulphatis— Liquoris Ferri Tersul- 
phatis— Solution of Ferric Sulphate. TJ. S. JP. 

Origin. — An aqueous solution of normal Ferric Sulphate, con- 
taining about 28.7 per cent, of the salt, and corresponding to about 
8 per cent, of metallic iron. 

Description and Properties. — A dark, reddish-brown liquid, 
almost odorless, having an acid, strongly styptic taste, and an acid 
reaction. Miscible with water and alcohol in all proportions, with- 
out decomposition. 

Dose. — 1-10 minims (0.06-0.6 Cc.), given in the same manner 
and for the same purposes as the preceding preparation. 

Pilulae Aloes et Ferri— Pilulas (ace.) Aloes et Ferri— 
Pills of Aloes and Iron. TJ. S. JP. 

Described under Aloes. 

Dose. — 5-10 grains (0.3-0.6 Gm.), or two or three pills. 

Emplastrum Ferri— Emplastri Ferri— Iron Plaster. 

TJ. S. B. 

(Strengthening Plaster.) 

Formula : Ferric Hydrate, 90 ; Olive Oil, 50 ; Burgundy Pitch, 
140; Lead Plaster, 720. For external use. 

Trochlsci Ferri— Trochlscos (ace.) Ferri— Troches of 

Iron. TJ. S. I>. 

Composition. — Ferric Hydrate; Vanilla; Sugar; Mucilage of 
Tragacanth. 

Dose. — One to two troches, each troche containing 5 grains 
(0.3 Gm.) of ferric hydroxide. 

Liquor Ferri Nitratis— Liquoris Ferri Nitratis— 
Solution of Ferric Nitrate. TJ. S. JP. 

Origin. — An aqueous solution of Ferric Nitrate, containing 
about 6.2 per cent, of the anhydrous salt, corresponding to about 
1.4 per cent, of metallic iron. 

Description and Properties. — A clear, amber-colored or red- 
dish liquid, odorless, having an acid, styptic taste, and an acid reaction. 

Dose. — 5-10 minims (0.3-0.6 Cc). 






HEM A TICS. 203 

PTIuIae Ferri Carbonatis— Pilulas (ace.) Ferri Car- 
bonatis— Pills of Ferrous Carbonate. U. S. P. 

(Ferruginous Pills — Chalybeate Pills — Blaud's Pills.) 
Dose. — 2 to 5 pills, each pill containing 1 grain (0.064 Gm.) 
of ferrous carbonate. 

Unofficial Preparations. 

Tinctura FSrri Acetatis — Tincturae FSrri Acetatis — Tincture of Ferric Ace- 
tate, U. S. P. — Composition: Solution of Ferric Acetate; Alcohol; Acetic Ether. 

Description and Properties. — A clear, dark, reddish-brown liquid, transparent in 
thin layers, having the odor of acetic ether, an acidulous and astringent taste, and a 
slightly acid reaction. Miscible in all proportions with water, without becoming turbid. 
The tincture should be kept in the dark and in a cool place. 

Dose. — 5-30 minims (0.2-2.0 Cc). 

FSrri Arsenas — FSrri Arsenatis — Iron Arsenate. — Description and Proper- 
ties. — A green or blue-green, amorphous powder, insoluble in water and in alcohol. 

Dose. — fa-\ grain (0.003-0.03 Gm.). 

FSrri Albuminas — FSrri Albuminatis — Albuminate of Iron. — Description 
and Properties. — Golden yellow, transparent scales, containing 3.34 per cent, of iron. 

Dose. — 5-30 grains (0.3-2.0 Gm.). A liquor and a syrup of albuminate of iron 
are used. 

FSrrum Dialysatum — FSrri Dialysati — Dialyzed Iron (Liquor Ferri Dia- 
lysatus — Liquor Ferri Oxychlorati). — Description and Properties. — Perfectly 
transparent, thin layers, of a deep brown-red color, inodorous, and almost destitute of 
styptic taste. Miscible with alcohol, glycerin, syrup, and distilled water, but not with 
spring- water or other, even dilute, saline solutions.' 

Dose. — 10-30 minims (0.6-2.0 Cc). 

Liquor FSrri Peptonati — Liquoris FSrri Peptonati — Solution of Peptonate 
of Iron. — Dose, \-2 fluidrachms (2.0-8.0 Cc). 

Liquor Mangano-FSrri Peptonatus — Liquoris M3ngano-FSrri Peptonati 
(Gude) — Solution of Peptonate of Iron and Manganese. — A proprietary prepa- 
ration from the formula of Dr. Gude. 

Dose. — 2-4 fluidrachms (8.0-15.0 Cc). 

Allied Compounds. 

Haemogallol. — Origin. — Prepared by the action of Pyrogallol on the coloring 
matter of the blood. 

Description and Properties. — A reddish-brown, tasteless powder. 

Dose — 1-8 grains (0.06-0.5 Gm.). 

Haemol. — Origin. — Prepared by the action of Zinc Dust on the coloring matter 
of the blood. 

Description and Properties. — A blackish-brown powder having a slight taste. 

Dose. — 1-8 grains (0.06-0.5 Gm.). 

Ferratin. — Origin. — A compound of Iron first obtained by Professor Schmiedeberg 
from hog's liver. 

Description and Properties. — A fine, reddish-brown powder containing about 7 per 
cent, of iron. One variety is insoluble, though the sodium ferratin is freely soluble in 
water. 



204 A TEXT-BOOK OF MATERIA MEDIC A. 

Dose. — 10-20 grains (0.16-1.2 Gm.). 

Haem albumin. — A preparation said to contain two albuminoids and salts of the 
blood. 

Description and Properties. — A permanent powder, soluble in water and in alcohol. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Haemoglobin. — Said to be the coloring principle of the solid elements of the blood. 

Dose. — 1-3 grains (0.06-0.18 Gm.). 

Haemoferrum. — Claimed to be a natural proteid compound of Iron obtained from 
bullock's blood. 

Dose. — 1-3 grains (0.06-0.18 Gm.). 

Iron Quinine Chloride. — A yellowish-red powder, soluble in water, alcohol, and 
glycerin. 

Dose. — 1-3 grains (0.06-0.18 Gm.). Used externally as a hemostatic. 



Antagonists and Incompatibles. — The ferric salts are incom- 
patible with tannic and gallic acids and vegetable astringents, and 
gelatinize mucilage of acacia. The carbonates are also incompatible 
with tannic and mineral acids and acidulous salts. 

The salts of the vegetable acids and the iodides are incompatible 
with mineral acids, tannic acid, and with alkalies and their carbon- 
ates. The tincture of the chloride of iron is also incompatible 
with tannic acid, vegetable astringents, alkalies and their carbon- 
ates, lime water, and the carbonates of calcium and magnesium. 

Synergists. — All the restorative medicines are synergistic. 

Physiological Action. — Iron is a typical restorative, being an 
essential element of the blood, there being 1 part of iron to 230 
of red globules. It has also been found in the gastric juice, bile, 
lymph, chyle, milk, urine, pigment of the eye, etc. This omni- 
presence is readily accounted for when it is remembered that the 
food of man contains iron in variable quantities. Indeed, this use- 
ful metal may well be called a respiratory nutrient because of its 
property of increasing the oxygen-carrying power of the red blood- 
corpuscles — muscular force and functional activity generally being 
dependent upon the supply of oxygen, or proper respiration, as 
the motive power. 

When the system is in a normal, healthy condition, sufficient 
iron is furnished by the mixed diet to answer all physiological 
requirements. In many diseased conditions, however, there is a 
deficiency of iron, and it is necessary to restore this element in 
one way or another. 

Other newer preparations of iron are Feraldoid, a peptonized albuminate of iron ; 
Fercremol, a compound of hemoglobin and iron, containing 3 per cent, of iron. Dose, 
3-8 grains (0.2-0.5 Gm.) ; Ferralbumose, prepared from fat-free meat and treated 
with artificial gastric juice ; the filtered solution is freed from albumin, filtered, neutral- 



HEM A TICS. 205 

ized, and dried in vacuo. A 10 per cent, solution of this albumose is precipitated by 
10 per cent, ferric chloride, and the precipitate is then dried and powdered. Ferro- 
pyrine, a combination with three molecules of antipyrine and one of ferric chlorid, and 
said to possess the properties of both constituents. Dose, 8 grains (0.5 Gm.) in anemic 
conditions associated with headaches and neuralgia. 

Ferrosol is a double saccharate of ferrous oxide and sodium chloride. It is not 
precipitated by the addition of acids, alkalies, or by changes in temperature. It con- 
tains 0.77 per cent, of iron. Ferrostyptin, an iron preparation containing formaldehyd 
and readily soluble in water, is used as a hemostyptic antiseptic. It is not caustic and is 
useful in the mouth and nose. Dose, 5-8 grains (0.3-0.5 Gm.). Ferrum caseina- 
tum, a preparation containing 5.2 per cent, ferric oxide and prepared by precipitating 
a solution of lactate of iron with a solution of calcium casemate. It is tasteless and 
odorless and soluble in water made alkaline by sodium carbonate. Dose, 5-15 grains 
(0.3-1.0 Gm.). Fersan is one of the many new preparations of blood. It is held to 
be the phosphoric acid containing albuminoids of the blood. Sanguinal, Sanguini- 
form, and Carniferrin are other blood preparations. Many other preparations of iron 
are daily being added to the already abundant list. 

The physiological effects upon the various systems, locally and 
internally, are now to be considered. 

Externally and Locally. — Neither the ferric nor the ferrous salts 
exert any action upon the unbroken skin. When applied, however, 
to mucous membranes or denuded surfaces, they are astringent and 
hemostatic, the ferric salts being the more powerful, coagulating 
albuminous fluids. When applied to bleeding surfaces the hemo- 
static action is due rather to the coagulation of the blood, forming 
a natural barrier to its escape, than to any direct action upon the 
walls of the vessels. The vegetable salts — scale preparations — 
possess so feeble astringent properties that they are rarely, if ever, 
used as local applications. 

The acid and astringent preparations of iron act upon the teeth. 
The ferric oxides are disinfectant, owing to their property of con- 
verting oxygen into ozone. 

Internally. — Digestive System. — The teeth and tongue are black- 
ened by the preparations of iron. In the stomach, when not con- 
traindicated and in small doses, its slightly irritant and astringent 
properties render iron quite a valuable stomachic tonic. Under 
excessive doses or prolonged administration the acid preparations 
especially are apt to cause gastric derangement — anorexia, nausea, 
and serious indigestion. The ferric chloride is particularly valu- 
able in that its ingestion does not, like that of other preparations 
of iron, diminish the supply of hydrochloric acid in the gastric juice. 

The scale salts, though disturbing the digestion less than the 
acid preparations, are ordinarily inferior to the latter. 



206 , A TEXT-BOOK OF MATERIA MEDICA. 

All the preparations of iron are probably converted into the 
chloride in the stomach. When entering the intestines they are 
converted into the ferric oxide, ferrous chloride, the alkaline albu- 
minate, and the insoluble sulphide and tannate. Most of the iron 
preparations are constipating, the phosphate and pyrophosphate 
being exceptions. They tend to diminish the bile and the secre- 
tions from the gastro-intestinal tract. 

Circulatory System. — The action of iron upon the blood is of 
great importance, since, the metal being a normal constituent 
of that fluid, its administration has a nutrient as well as a medicinal 
influence. A primary effect is to supply a deficiency of red cor- 
puscles and bring the hemoglobin up to the normal standard. 
Iron enables the red corpuscles to convey more oxygen to the 
tissues, converting that element into ozone and thereby rendering it 
more active in promoting oxidation. The muscular power of the 
heart is increased, the arterioles slightly contracted, and arterial 
tension somewhat raised. 

Nervous System. — The general effect is tonic, the influence of 
iron and its salts being highly beneficial in strengthening the action 
of the nerves in cases of physical debility. With subjects inclined 
to plethora, however, certain untoward symptoms may result from 
administration of the stronger preparations, including a feeling of 
congestion in the cerebrum. 

Respiratory System. — No immediate action is perceptible under 
normal conditions, but in anemic states, by supplying the nerve- 
centers, muscles, and lungs with better blood, the respiratory power 
is increased. 

Absorption and Elimination. — Opinions differ regarding the form 
in which iron is absorbed. Probably much of it is converted into 
the soluble chloride and absorbed as such in the stomach, — while 
a portion, passing into the intestines, may there be converted into 
the soluble alkaline albuminate capable of absorption. The larger 
portion of iron taken into the system, however, is changed into the 
insoluble sulphide and tannate, and excreted as such, giving to the 
feces a black color. Such part of the iron as enters the circulation 
combines with the red corpuscles. The salts of the organic acids 
are absorbed directly into the blood. 

Such careful pharmacologists as Bunge, Schmiedeberg, and 
Hamburger claim that inorganic preparations of iron are neither 
absorbed nor assimilated, maintaining that the blood and hemo- 
globin are influenced only by the organic compounds. Yet, not- 






HEM A TICS. 207 

withstanding these statements, clinical experience has fully- demon- 
strated the value of such preparations as reduced iron, tincture of 
the chloride, carbonate, etc. ; and it is still perhaps a mooted ques- 
tion whether appreciable amounts of them are actually absorbed, 
or whether, according to Bunge, the inorganic prevent the decom- 
position of the organic salts of iron in the food by fixing the 
decomposing agents in the intestines. At all events, the beneficial 
results in anemia and chlorosis of large doses of the inorganic 
preparations are too manifest to justify abandonment of these 
agents because of our ignorance touching their modus operandi. 

Bunge's hypothesis would at least seem plausible when it is 
remembered that only traces of iron can be found in the urine 
when the drug is given by the stomach, while if injected into the 
circulation large quantities are eliminated by the kidneys. It is 
quite possible that the improvement in the red corpuscles, and the 
promotion of oxidation independent of them, take place in the 
portal circulation, and that when the iron reaches the liver it is 
there intercepted and, together with the bile, turned back into the 
intestines. 

At the present time it is fairly well conceded that Bunge was 
wrong in his general theory, and the recent work of many phar- 
macologists has shown that most of the ordinary preparations are 
capable of absorption in the intestine, and it is also probable that 
iron takes part in a number of synthetic combinations in the liver, 
some of which may be utilized in normal metabolism, while 
others are cast off in the bile and thus reenter the intestinal canal. 

The amount of urea is increased and micturition rendered more 
frequent by preparations of this metal. 

Elimination takes place chiefly by the feces, to which a blackish 
color is imparted by the formation of ferrous sulphide. The bile, 
urine, and even the skin, as well as the mucous and serous mem- 
branes, share in the excretory process. 

Temperature. — The administration of iron tends to raise bodily 
heat in the sick. This may be due only to the normal influence 
of the metal, the ozonizing power of which, affecting the promo- 
tion of tissue-waste, naturally causes an elevation of temperature. 

Untoward Action. — The continued use of ferruginous prepara- 
tions has a tendency to impair the normal digestive powers, occa- 
sioning even gastric oppression, nausea, and vomiting. Reduced 
iron, the phosphate, and the pyrophosphate produce less untoward 
action than other preparations, and the ferrous are better tolerated 



208 A TEXT-BOOK OF MA TERIA MEDICA. 

than the ferric salts. Not infrequently acne of the face, breast, 
and back is occasioned, while the prolonged administration of the 
drug may in rare cases be accompanied by hemorrhages from 
the mucous membranes and symptoms of plethora and vascular 
excitement. Large doses of the ferrous sulphate may occasion 
obstruction of the bowels. In some rare instances irritation of the 
kidneys may be induced, and again iron is often badly tolerated in 
gouty conditions. 

Poisoning. — The ferric preparations in a concentrated form pro- 
duce all the symptoms of an irritant poison — gastric pain, vomit- 
ing, etc. 

Treatment of Poisoning. — The stomach should be emptied by 
an emetic or carefully cleansed, the treatment being followed by 
the administration of alkali solutions, tannic acid, and demulcent 
drinks, the procedure being similar to that employed in poisoning 
from mineral acids. 

Therapeutics. — Externally and Locally. — The astringent and 
styptic properties of chlorides and sulphates of iron have rendered 
them serviceable in controlling hemorrhage and as local astrin- 
gents in relaxed conditions of the pharynx and larynx and mucous 
membranes generally. The tincture of the chloride has been 
highly recommended as a local application to the throat in diph- 
theria, and chronic and indolent ulcers may often be benefited by 
a wash containing from 2 to 5 grains (0.12-0.3 Gin.) of the sulphate 
to 1 ounce (30.0 Cc.) of water. 

It is important to remember that it is bad surgery to use the 
astringent salts of iron in deep wounds or even in superficial ones. 
Pressure will usually fulfill all the indications of an astringent. 

Internally. — The most important use of iron is to restore the num- 
ber of red corpuscles and the amount of hemoglobin. In nearly 
every form of anemia, therefore, iron is indicated. In chlorosis, es- 
pecially, it is of great value; but in order that its effects may be most 
beneficial cathartics, such as rhubarb and aloes, which do not weaken 
the intestines, should accompany its use. Even the anemia due to 
hemorrhage calls for iron ; yet if the assimilative functions are not 
impaired, the drug should be reinforced by plenty of nutritious food, 
from which the constituents of the blood are normally elaborated. 

The anemia of scrofula and syphilis is benefited by some form 
of iron, care being taken in these cases to select the proper salts. 
In glandidar scrofula, for instance, the iodide is to be preferred, 
and, theoretically, this salt is preferable also in syphilis, yet in the 



HEM A TICS. 209 

latter disease the efficacy of the salt depends less upon its particular 
radical than upon its restorative properties and its power of counter- 
acting the depressing and mischievous effects so often produced by 
excessive use of the remedy. 

In the desquamative forms of Bright 's disease iron is of signal 
benefit. In this condition the blood-disks are rapidly destroyed 
by the urea ; moreover, certain preparations of iron possess quite 
a local action upon the kidney. Iron is also useful in jaundice 
where there is more or less cholemia, with destruction of the red 
corpuscles. 

Many nervous disorders dependent upon anemia are relieved by 
iron. Even in chorea and various neuralgias — especially those of 
an intermittent nature arising from an impoverished state of the 
blood — iron is of decided value. In many chronic nervous diseases, 
however, good judgment in the use of the drug is necessary, lest 
it prove more prejudicial than advantageous. 

In anemia of certain cardiac diseases iron is of unquestioned 
value, though the fact is well known to observant practitioners that 
in these cases iron alone is but a single element in the successful 
treatment of them. 

While iron is of great service in lessening the muco-purulent ex- 
pectoration of chronic bronchitis, its influence in ptdmonary tuberculo- 
sis is less favorable. At times the drug appears to improve the con- 
dition of phthisical patients early in the disease, yet more frequently 
it induces hemoptysis and hastens the progress of the malady. In 
certain disorders of the genito-urinary tract — prolapsus uteri, incon- 
tinence of urine, seminal emissions, prostatorrhea, etc. — iron is an 
appropriate remedy. It is an important agent in the treatment 
of diabetes, though care should be taken to guard against its 
tendency to constipate the bowels. 

As observed later on, iron is contraindicated in febrile diseases, 
yet it is a matter of clinical experience that the drug acts favorably 
in modifying the course of idiopathic erysipelas, pyemia, septicemia . 
and diphtheria. 

The astringent action of iron is available in the treatment of 
vagi?tal leucorrhea, hematemesis, and passive hemorrhages from the 
uterus, bladder, kidneys, etc. It has also proved highly beneficial 
in certain forms of chronic diarrhea and dysentery. In amenorrhea 
and menorrhagia, when due to a deficiency of normal blood, iron 
is an extremely valuable remedy. 

Contraindications. — Iron is usually contraindicated in fever 

14 



2IO A TEXT-BOOK OF MATERIA MEDIC A. 

and acute inflammatory conditions, in anemia of malignant disease, 
such as cancer, in Addison's disease, and in the hemorrhagic diath- 
esis. Should the use of iron derange digestion or aggravate 
hemorrhoidal conditions, the drug should be discontinued or care- 
fully administered, being associated with stomachics or laxatives 
to mitigate its untoward effects. 

Administration. — If the appetite be poor, iron should be ad- 
ministered in small doses (invariably after meals) or preceded by 
vegetable bitters. The tincture of the chloride and the stronger 
preparations should be freely diluted with water. The citrate of 
iron is a mild preparation well adapted for children and persons of 
delicate stomach. 

Probably the salt richest in iron, yet of all the ferruginous 
preparations the most agreeable and least irritating, is the iron and 
potassium tartrate. The soluble ferric pyrophosphate is also a 
mild and pleasant preparation. The compound iron mixture pos- 
sesses special advantages in the treatment of chlorosis and chronic 
diseases of the skin, while the solution of iron and ammonium 
acetate (Basham's mixture) is the best preparation in albuminuria — 
particularly that accompanying tubular nephritis — it being agree- 
able and well tolerated. 

The best styptic is the ferric subsulphate or its solution. 

Dialyzed iron, being agreeable to the taste, was formerly a pop- 
ular remedy. 

Although it has been shown that Bunge's theory of the ina- 
bility of the body to utilize inorganic salts of iron is untrue, yet 
many of the newer proteid combinations serve very acceptably in 
modern therapeutics, especially in those rare cases in which marked 
idiosyncrasies to the effects of iron exist. Apart from such, how- 
ever, there is, we believe, little justification, from an economic point 
at least, in the use of the numerous patented sherry wine combina- 
tions of iron salts. A good wine with the old-fashioned prepara- 
tions will give as good results at less expense to the patient. 

Manganum-Mangani- Manganese. 
This metal is a normal constituent of the body, existing in ap- 
preciable though minute quantities in the blood, bile, etc. From 
the fact of its presence in the blood, and because of the similarity 
of its chemical affinities to those of iron, theorists, rather than 
careful and practical observers, have advocated its use as a worthy 
and efficient substitute for the latter agent. 



HEMATICS. 211 

Its therapeutic uses as a restorative, or as an alternative or 
synergist to iron, are based more upon abstract deductions than 
upon clinical observation. Still, as its chemical character resem- 
bles that of iron — though the metal in its operation is often 
antagonistic to the latter — its salts are of sufficient therapeutic 
importance to merit brief mention here. 

Mangani Dioxidum— Mangani Dioxidi— Manganese 
Dioxide. U. 8. JP. 

(Black Oxide of Manganese.) 

Origin. — Native, crude manganese dioxide, containing at least 
66 per cent, of the pure dioxide. 

Description and Properties. — A heavy, grayish-black, more or 
less gritty powder, without odor or taste ; permanent in the air ; 
insoluble in water or alcohol. 

Dose. — 5-40 grains (0.3-3.0 Gm.). 

Mang-ani Sulphas— Mangani Sulphatis— Manganese 
Sulphate. U. 8. JP. 

Origin. — Obtained by heating Manganese Dioxide with suf- 
ficiently strong Sulphuric Acid, evaporation, and crystallization. 

Description and Properties. — Colorless or pale rose-colored, 
transparent, tetragonal prisms, odorless, and having a slightly bitter 
and astringent taste ; slightly efflorescent in dry air. Soluble in 
0.8 part of water and in 1 part of boiling water ; insoluble in alco- 
hol. Manganese sulphate should be kept in well-stoppered bottles. 

Dose. — 2-5 grains (0.1-0.3 Gm.). 

(For Potassium Permanganate see section on Antiseptics^ 

Antagonists and Incompatibles. — The salts of lead, silver, and 
mercury are incompatible with manganese. 

Synergists. — Iron is theoretically synergistic, and the salts of 
zinc, copper, and silver are similar in their action on the nervous 
system. 

Physiological Action. — Externally and Locally. — The two salts 
above mentioned have no important local action. 

Internally. — In large doses these salts, especially the sulphate, 
irritate the gastro-intestinal tract, while excessive doses may even 
occasion gastro-enteritis. The sulphate acts as an emeto-cathartic 
and possesses cholagogue properties. 

As is the case with many other drugs of this character, small 
doses may even promote the appetite and improve the digestive 



212 A TEXT-BOOK OF MATERIA MEDIC A. 

function. Large doses, or the continued administration of these 
preparations, affects the system more like zinc than iron, pro- 
ducing great depression, muscular weakness and waste, diminishing 
the pulse-beat, weakening the heart, and lowering arterial tension. 
There is, moreover, a tendency to fatty degeneration of the muscles 
and liver. 

Therapeutics. — The manganese dioxide is highly beneficial in 
amenorrhea and dysmenorrhea, and has been used in the treatment 
of gastralgia, pyrosis, and simple ulcer of the stomach. Its action 
probably resembles that of bismuth, though it is a much less 
efficient remedy than the latter drug. 

It is of interest to note that many practitioners say that they 
derive no benefit from the use of manganese salts alone in the 
treatment of amenorrhea. 

The sulphate is used occasionally as a cholagogue purgative in 
malarial jaundice, although why it should be preferred to many 
other and superior cholagogues it is difficult to understand. Gouty 
dyspepsia appears to have been much improved by the use of 
manganese. The association of iron and manganese makes a 
valuable combination in the treatment of chlorosis and many 
variations of anemia. 



Phosphorus— Phosphori— Phosphorus. TJ. S. JP. 

Origin. — It exists, chiefly as phosphates, in many minerals and 
in all plants and animals. It is prepared by treating Calcined 
Bones with Sulphuric Acid, evaporation, and distillation. 

Description and Properties. — A translucent, nearly colorless 
solid, of a waxy luster, having at ordinary temperatures about the 
consistence of beeswax. When kept for some time the surface 
becomes red and occasionally black. Phosphorus has a distinctive 
and disagreeable odor and taste (tasting being allowable only in the 
form of extreme dilutioit). When exposed to the air it emits white 
fumes, visible in the dark, which have an odor somewhat resem- 
bling that of garlic. Upon prolonged exposure to air it takes fire 
spontaneously. 

Phosphorus is insoluble, or nearly so, in water, to which, how- 
ever, it imparts its characteristic disagreeable odor and taste. It is 
soluble in 350 parts of absolute alcohol, in 80 parts of absolute 
ether, and in about 50 parts of any fatty oil. It is very soluble in 
chloroform or in carbon disulphide, the latter yielding a solution to 



HEMATICS. 213 

be handled with the greatest care to prevent accident from combus- 
tion. The drug should be carefully kept under water, in strong, 
well-closed vessels, in a secure and moderately cool place protected 
from light. 

Dose. — 1 1 3^ grain (0.0006-0.002 Gm.). 

Official Preparations. 

Oleum Phosphoratum — Olei Phosphorati — Phosphorated Oil.— Dose, 1-5 
minims (0.06-0.3 Cc). A clear, yellowish liquid, having the odor of phosphorus and 
of ether, but not phosphorescent in the dark. It should be perfectly free from particles 
of undissolved phosphorus. 

Pilulae Ph6sphori — Pilulas (ace.) Phftsphori — Pills of Phosphorus. — Dose, 
one to two pills. Each pill contains yi^ grain (0.0006 Gm.) of phosphorus. 

Spfritus Ph6sphori — Spiritus PhSsphori — Spirit of Phosphorus (Tincture 
of Phosphorus). — Dose, 5-30 minims (0.3-2.0 Cc). 

Elixir Phdsphori— Elixir Phbsphori — Elixir of Phosphorus. — Dose, \-2 fluid- 
drachms (2.0-8.0 Cc). 



Antagonists and Incompatibles. — The principal chemical anti- 
dotes are hydrated magnesia, lime water, powdered charcoal, cop- 
per sulphate, and old acid turpentine. 

Synergists. — Cod liver oil and the Restoratives generally aid 
the action of phosphorus. It is claimed that arsenic and sulphur 
are also synergistic. 

Physiological Action. — Externally and Locally. — Applied to 
the skin, phosphorus causes local inflammation, ulceration, and 
possibly gangrene. The fumes may produce the most serious 
results — even maxillary necrosis where dental caries is present, as 
well as great irritation of the conjunctivae and the respiratory 
mucous membrane. The graver systemic symptoms are confined 
to the conditions induced by toxic doses of the drug. 

Internally. — Digestive System. — Taken into the stomach, no 
special effect is apparent as a result of small doses, save that the 
drug acts as a functional stimulant. Larger amounts have been 
held to impede digestion by impairing the action of the gastric 
juice upon albuminoid materials. Immoderate doses occasion 
great irritation of the stomach and intestines, accompanied by 
abdominal distress, vomiting, and purging. Jaundice is a not 
infrequent result of ingestion, due to obstruction of the biliary 
ducts. Minute quantities stimulate the nutrition of the tissues, 
especially that of the osseous system. 



214 A TEXT-BOOK OF MATERIA MEDICA. 

Circulatory System. — The primary action is stimulating, the 
pulse rising and acquiring additional force, though not firmness. 
The facial capillaries are expanded, often congested ; the cutaneous 
circulation becomes more rapid; and diaphoresis is produced. 
Under toxic doses the action of the heart is strongly depressed. 

Nervous System. — In repairing the waste of tissue phosphorus 
acts upon the nervous system as a tonic, improving the nutrition 
of debilitated parts and restoring to normal conditions the func- 
tional activity of organs and tissues. Small or moderate doses act 
as stimulants to the entire nervous system, intellectual activity 
being promoted and the sexual appetite increased. Toxic effects 
include coma, and occasionally vertigo, with delirium, convulsions, 
insensibility, and collapse. 

Respiratory System. — The deleterious action of the fumes of 
phosphorus is exemplified in their irritating effect upon the broncho- 
pulmonary mucous membrane. Toxic symptoms are often accom- 
panied by serious disturbances, respiratory failure being among the 
immediate causes of death. 

Absorption and Elimination. — The modus operandi of absorption 
is a matter of some dispute. Probably a portion of the drug 
undergoes oxidation in the stomach, and the phosphoric acid 
formed, combining with the alkalies, enters the blood as phos- 
phates. A part of the phosphorus is dissolved in the fats and oils 
present in the stomach, probably entering the circulation as ele- 
mentary phosphorus. 

The drug, having undergone oxidation in the system, is elim- 
inated as ortho-phosphoric acid, chiefly by the urine, increasing 
the excretion of urinary phosphates. The liver shares in the 
excretory process. 

Temperature. — Owing to capillary expansion, the superficial 
temperature is at first slightly raised, being subsequently dimin- 
ished. Evaporation and radiation, arising from profuse diaphoresis, 
contribute to thermal reduction. 

Eye. — In chronic poisoning from phosphorus hemorrhages and 
patches of degeneration in the retina are sometimes visible, the 
ophthalmoscopic picture resembling the retinitis of albuminuria. 
Under medicinal doses no special effects upon the eye are reported, 
although, as has been stated, the vapor of phosphorus is highly 
irritant to the conjunctivae. 

Uterus. — The action of phosphorus tends to increase the men- 
strual flow. 



HEMATICS. 215 

Untoward Action. — Small doses produce in some individuals 
severe gastric disturbance, and in rare cases diarrhea, tenesmus, 
and jaundice. The fatty degeneration of the retinal capillaries 
mentioned above — such as results from chronic intoxication affect- 
ing workers in match-factories — is an untoward manifestation to 
be guarded against by every available means. 

Poisoning. — The effects of a fatal dose of phosphorus are not. 
immediate. After a lapse of several hours great weakness occurs, 
accompanied in a large majority of cases by vomiting. Abdominal 
pains follow, the symptoms becoming more acute, mucus and bile 
being present in the ejecta, which for a while retain the odor and 
luminosity of phosphorus. With the cessation of vomiting pain 
is abated, although it may extend over the entire abdominal region 
and even be attended with paroxysms. 

The foregoing symptoms are accompanied by pronounced 
anorexia, thirst and fever, a thickly-coated or whitish tongue, 
burning in the throat, and often signs of collapse. The temper- 
ature at first reaches nearly the maximum possible without proving 
fatal, subsequently sinking below the normal. After thirty-six 
hours or more jaundice sets in. The urine is diminished, becom- 
ing charged with albumin and urates, and even bloody, containing 
among other ingredients biliary acids and coloring-matter. In fatal 
cases urea is almost wholly wanting. The stools may be normal, 
but the general condition is usually marked by diarrhea or consti- 
pation and flatulence. Hemorrhage often occurs, wounds bleeding 
profusely, and as the severity of the symptoms increases delirium 
ensues, or coma terminating in convulsions. 

Serious nervous manifestations are frequently preceded by rest- 
lessness, insomnia, headache, and vertigo. In some delirious con- 
ditions wild, erotic states of the mind are the precursors of convul- 
sive or comatose symptoms. Somnolence is not uncommon, with 
partial spasms and contraction or paresis of the voluntary muscles. 
Post-mortem examination shows that the liver, heart, kidneys, mus- 
cles, capillaries, and arterioles are implicated in the general effects 
of the poisoning, and are undergoing fatty degeneration. 

Sometimes the preponderating influence of the poison affects 
the bronchial and gastro-intestinal mucous membranes, or it may 
visit the nervous system or be manifested in the circulatory sys- 
tem. In cases of acute poisoning the duration of the malady 
varies greatly, death occurring at times within a few days, or, again, 
being deferred for a few weeks. As a rule, recovery is retarded, 
the elimination of the drug requiring time. 



2i6 A TEXT-BOOK OF MATERIA MEDICA. 

The symptoms of chronic poisoning are in some respects espe- 
cially marked, inhalation of phosphorus-fumes frequently resulting 
in pronounced conditions of necrosis, particularly of the lower max- 
illary, although it has been maintained that this feature of the poi- 
soning is contingent upon denuded surfaces of bone, disintegration 
or softening of tissues, caries of the teeth, or communicating wounds. 
Very rarely the palate and frontal bones are similarly attacked. 

Treatment of Poisoning. — Emetics and purgatives are of the 
first necessity. Copper sulphate is the most efficient emetic as well 
as the best chemical antidote. Hydrated magnesia, charcoal, and 
lime water have been suggested, yet their action is tardy, and a 
more efficient antidote is desirable. Several chemical and physio- 
logical agents have been employed to counteract the effects of the 
drug, among them old acid (oxygenated) oil of turpentine and 
potassium permanganate in a \ per cent, solution, opium being 
used as a stimulant to the heart and the circulatory system. 

As prophylactic measures for the protection of workmen against 
phosphor-necrosis, masks covering mouth and nose have been 
found serviceable, as well as inhalation of the vapor of turpentine 
obtained by suspending a small bottle of the fluid about the neck. 
The teeth should be kept constantly in good condition, since caries 
favors the tendency to necrosis. 

Therapeutics. — Phosphorus is not used externally, but inter- 
nally it is a food, especially of the nervous and osseous systems, 
stimulating protoplasmic activity, although, according to Gubler, 
" phosphorus is a rapid stimulant, but it acts by causing waste, and 
not by increasing power ; it impoverishes, and does not enrich ; 
it momentarily galvanizes, as it were, the torpid functions, but is 
incapable of renewing a dilapidated constitution or even a nervous 
system exhausted by chronic disease." 

Clinical experience has certainly demonstrated its utility as a 
nutrient tonic to the nervous and osseous tissues. In neurasthenia 
and chronic nervous exhaustion it is highly efficacious. Some cases 
of neuralgia, particularly of the fifth nerve and accompanied by 
great debility, may be relieved by full doses administered every 
four hours. 

It is claimed by competent observers that certain cases of angina 
pectoris have been completely relieved by phosphorus. 

It has proved of great value in caries, delayed resolution of bone, 
osteomalacia, and rhackitis, and the drug is credited with the cure of 
pernicious anemia, though it is singular, if the drug possesses any 



HEMATICS. 21 J 

real value in this disease, that the fact has been recognized by so 
few observers. Such able men as Fox and Broadbent praise its effi- 
cacy in lymphadenoma. The insomnia of the aged and the wakeful- 
ness of cerebral anemia and exhaustion usually yield to this remedy. 

As to its aphrodisiac effects there is great difference of opinion, 
some physicians believing it to be a most powerful agent in reliev- 
ing functional impotence, while others — among them so enthusiastic 
an advocate of phosphorus as Thompson — conclude that the drug 
is inefficient for this purpose unless given in larger doses than 
safety prescribes. The enthusiastic praise of its eulogists, however, 
as a remedy in impotence of a functional character is of so con- 
vincing a nature as to certainly justify an extended trial in this 
condition. Scarcely less is the testimony regarding its efficacy in 
chronic psoriasis, lepra, lupus, and acne indurata. 

Administration. — Since many persons have a peculiar suscepti- 
bility to phosphorus, its administration should begin with small 
doses, and, should it be thought necessary to prolong the adminis- 
tration for an indefinite period, the tendency of the drug to produce 
general steatosis should not be forgotten. 

The phosphorus pill is undoubtedly the best form in which to 
administer the drug, though it possesses the disadvantages of being 
insoluble in the intestinal fluids and of producing more or less 
irritation of the gastro-intestinal mucous membrane, though the 
latter effect is usually unnoticed under ordinary medicinal dosage 
on a full stomach. The liquid preparations of phosphorus are 
more unstable, tending to become rapidly inert by oxidation. 

The spirit of phosphorus is sometimes given in cod-liver oil or the 
elixir of calisaya. Phosphorated oil and liquor phosphori (Thomp- 
son's solution) are highly recommended by competent authorities. 

Calcii Hypophosphis— Calcii Hypophosphltis— Cal- 
cium Hypophosphite. TJ. S. JP. 

Origin. — Obtained by heating Phosphorus with Milk of Lime 
and exposing the mixture to the air. 

Description and Properties. — Colorless, transparent, mono- 
clinic prisms, or small, lustrous scales, or a white, crystalline 
powder; odorless, having a nauseous, bitter taste, and permanent 
in the air. Soluble in 6.8 parts of water and in 6 parts of boiling 
water; insoluble in alcohol. 

Dose. — 5-6 grains (0.3-0.4 Gm.). 



218 A TEXT-BOOK OF MATERIA MEDIC A. 

Calcii Phosphas Praecipitatus— Calcii Phosphatis 
Praecipitati— Precipitated Calcium Phosphate. 
U. S. I>. 

Origin. — Prepared by the action of Hydrochloric Acid and 
Water upon Bone-ash, the addition of Solution of Ammonia to 
render the mixture of an alkaline reaction, and washing and drying 
the precipitate. 

Description and Properties. — A light, white, amorphous pow- 
der, odorless and tasteless, permanent in the air. Almost insoluble 
in cold water ; partly decomposed by boiling water, which dissolves 
out an acid salt ; almost insoluble in acetic acid, except when 
freshly precipitated ; easily soluble in hydrochloric or nitric acid ; 
insoluble in alcohol. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Sodii Hypophosphis— Sddii HypophosphTtis— 
Sodium Hypophosphite. U. S. JP. 

Origin. — Prepared by adding Sodium Carbonate to a solution 
of Calcium Hypophosphite and evaporating the filtrate. 

Description and Properties. — Small, colorless, transparent, rec- 
tangular plates of a pearly lustre, or a white, granular powder, 
odorless, and having a bitterish-sweet, saline taste. Very deliques- 
cent on exposure to moist air. Soluble in 1 part of water and in 
30 parts of alcohol, also in 0.12 part of boiling water and in I part 
of boiling alcohol ; slightly soluble in absolute alcohol ; insoluble 
in ether. Sodium hypophosphite should be kept in well-stoppered 
bottles. 

Dose. — 5-10 grains (0.3-0.6 Gm.). 

Potassii Hypophosphis— Potassii Hypophosphitis— 
Potassium Hypophosphite. U. S. JP. 

Origin. — Prepared in a similar manner to Calcium Hypophos- 
phite, or by double decomposition of Calcium Hypophosphite and 
Potassium Carbonate. 

Description and Properties. — White, opaque, hexagonal plates, 
or crystalline masses, or a granular powder, odorless, and having a 
pungent, saline taste ; very deliquescent. Soluble in 0.6 part of 
water and in 7.3 parts of alcohol. Potassium hypophosphite 
should be kept in well -stoppered bottles. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 



HEMATICS. 219 

Acidum Hypophosphorosum Dilutum— Acidi Hypo- 
phosphorosi Diluti— Diluted Hypophosphorous 
Acid. U. S.I>. 

Origin. — Prepared by decomposing Potassium Hypophosphite 
by Sulphuric Acid, filtering, and evaporating to a syrupy consist- 
ence. It contains 10 per cent, by weight of absolute hypophos- 
phorous acid. 

Description and Properties. — A colorless liquid, without odor, 
and having an acid taste. Specific gravity about 1.046. Miscible 
in all proportions with water. 

Dose. — It is never used as a therapeutic agent by itself, but in 
the syrup of the hypophosphites. 

Syrupus HypophosphTtum— Syrupi Hypophosphl- 
tum— Syrup of Hypophosphites. 

Formula : Calcium Hypophosphite, 45 ; Sodium Hypophos- 
phite, 1 5 ; Potassium Hypophosphite, 1 5 ; Diluted Hypophos- 
phorous Acid, 2; Spirit of Lemon, 5; Sugar, 500; sufficient 
Water to make 1000. 

Dose. — 1-2 fluidrachms (4.0-8.0 Cc). 

Syrupus HypophosphTtum cum Ferro— Syrupi Hy- 
pophosphTtum cum Ferro— Syrup of Hypophos- 
phites with Iron. 

Formula: Ferrous Lactate, 10; Potassium Citrate, 10; Syrup 
of the Hypophosphites, to 1000. 

Dose. — 1-2 fluidrachms (4.0-8.0 Cc). 

ZInci Phosphidum— Zinci Phosphidi— Zinc 
Phosphide. U. S. JP. 

Origin. — Prepared from Vapor of Phosphorus in a current of 
Dry Hydrogen over heated Zinc, after all atmospheric air has been 
expelled. 

Description and Properties. — A gritty powder of a dark-gray 
color, or crystalline fragments of a dark, metallic luster, and having 
a faint odor and taste of phosphorus. In contact with air it slowly 
emits phosphorous vapor. Insoluble in water or alcohol. Zinc 
phosphide should be kept in small glass-stoppered bottles. 

Dose. — jlg-4- grain (0.004-0.02 Gm.). 



220 A TEXT-BOOK OF MATERIA MEDIC A'. 

Antagonists and Incompatibles. — The sodium and potassium 
hypophosphites are incompatible with the soluble salts of mercury 
and silver, and the soluble phosphates and carbonates are incom- 
patible with calcium hypophosphite. Zinc phosphide is decom- 
posed by mineral acids. 

Synergists. — Phosphorus, cod liver oil, and the Restoratives 
generally. 

Physiological Action. — Although not possessing the active 
and poisonous properties of phosphorus, the hypophosphites are 
similar in their effect to small doses of phosphorus — i. e. in stimu- 
lating and regenerating the nervous system and those tissues 
which contain phosphorus and lime. 

The calcium phosphate possesses no action superior to that of 
the hypophosphite, and its virtues are chiefly those of the hypo- 
phosphite. 

The phosphate is soluble to a slight extent in lactic and hydro- 
chloric acids, so that when taken by the stomach a portion diffuses 
into the blood. 

The zinc phosphide is more active, and resembles more closely 
the action of phosphorus, and in too large doses it irritates the 
stomach in the same manner as uncombined phosphorus. 

Therapeutics. — Externally and Locally. — The calcium phos- 
phate, combined with a little free phosphoric acid, has been 
recommended by Doubenski in the treatment of tuberculous ulcera- 
tions. "Cold abscesses and fistulous tracts were treated by packing 
with gauze soaked with a solution of 5 parts to 100." 

Internally. — The hypophosphites may be employed for the same 
conditions as those in which phosphorus is used. In chlorosis, 
anemia, scrofula, and tuberculosis they have been highly recom- 
mended. In the author's opinion, in the cachexias mentioned the 
benefit derived from their use is slight compared with that of cod 
liver oil and the hygienic influences rendered serviceable in these 
conditions. 

The praise bestowed upon calcium phosphate consists largely 
of assertions rather than evidence : if it possesses any therapeutic 
value, it is chiefly that of the hypophosphite. 

The zinc phosphide has medicinal virtues greatly superior to 
those of the preparations above mentioned. In nervous disorders 
dependent upon defective nutrition it is equal, if not superior, to 
phosphorus, and it may be employed for any condition in which 
the latter drug is useful. 



HEMATICS. 221 

Administration. — The zinc phosphide is best given in pill form. 
The hypophosphites and calcium phosphate may be given in cap- 
sules, though the syrup of the hypophosphites is usually preferred. 
It is a question whether the sugar which the syrup contains may 
not tend to induce or aggravate the gastric fermentation so often 
present in cases requiring the use of a reconstituent 

Cinchona— Cinchonae— Cinchona. IT. S. JP. 

Origin. — The bark of Cinchona Calisaya Weddell, Cinchona 
officinalis L., and of their hybrids and those of other species 
of Cinchona, yielding, when assayed by the process given in the 
U. S. Pharmacopoeia, " not less than 5 per cent, of total alkaloids 
and at least 2.5 per cent, of quinine." The genus Cinchona 
as at present constituted consists of from thirty-one to thirty-six 
species, all of which are native to South America. The habitat 
of the tree follows the eastern slope of the Andes, beginning in 
Bolivia and extending through Peru. From about 2° south lati- 
tude in Ecuador it occupies also the eastern slope of the Western 
Cordilleras, until by two narrow belts it enters the highlands of 
New Granada, whence it spreads northeast and northward into 
Venezuela, reaching the vicinity of Caracas and the Caribbean 
Sea. Owing to the great number of hybrids the delimitation of 
the various species of Cinchona is, at the present time, almost an 
impossible task. 

The climate in which the most valuable species are found is, 
according to Karsten(i858), characterized by a rainy season lasting 
for nine months, heavy rains falling principally during the night, 
alternating with sunshine and fog during the day. During the 
remaining three months of the year the nightly temperature fre- 
quently sinks below freezing-point, in the day-time, however, 
reaching 25 ° C. (jj° F.), producing dense fogs. 

The Cinchonas are evergreen trees or shrubs, the most valuable 
species attaining a height of from 40 to 80 feet (12 to 24 M.). 
They are not met with in the valleys, but are found at altitudes 
varying from 330 feet (100 M.) to 11,500 feet (3500 M.). Accord- 
ing to Weddell, the most valuable species grow at an altitude of 
5300 to 7900 feet (1600 to 2400 M.). All the species are found 
in the primeval forests, either singly or in collections of a few 
specimens. The tree is cultivated in British Sikkim, Ceylon, Java, 
and Jamaica. It is also cultivated in South America, its original 
home. 



222 A TEXT-BOOK OF MATERIA MEDICA. 

Description and Properties. — In quills or in curved pieces, 
varying in length, and usually y 1 ^ or i * ncn ( 2 or 3 Mm.), or some- 
times ^ inch (5 Mm.), thick ; the outer surface covered with a gray 
or brownish-gray cork, usually slightly wrinkled, marked with 
transverse and also intersecting longitudinal fissures (C Calisayd), 
and sometimes with scattered warts and slight longitudinal ridges ; 
inner surface light cinnamon-brown, very highly striate ; fracture 
of the outer layer short and granular, finely fibrous in the inner 
layer ; powder light- or yellowish-brown ; odor slight, somewhat 
aromatic; taste bitter and somewhat astringent. 

Cinchona Rubra— Cinchonae Rubrae— Red Cin- 
chona. XI. S. JP. 

Origin. — The bark of Cinchona succirubra Pavon, containing not 
less than 5 per cent, of its peculiar alkaloids. 

Description and Properties. — In quills or in curved pieces, 
varying in length, and from -^ to \ or \ inch (2 to 4 or 5 Mm.) 
thick ; the outer surface covered with a grayish-brown cork, more 
or less rough from warts and longitudinal warty ridges, and few, 
mostly short, transverse fissures ; inner surface more or less deep 
reddish-brown and distinctly striate ; fracture short-fibrous in the 
inner layer ; powder reddish brown ; odor slight ; taste bitter and 
astringent. 

Among the various alkaloids found in cinchona the following 
are the most important : Quinine, quinidine, cinchonine, and cin- 
chonidine, the medicinal value of the bark depending almost exclu- 
sively upon the alkaloid quinine. 

Other less important ingredients are kinic and kinovic acids, 
kinovin, cinchotannic acid, cinchona-red, and a minute quantity of 
a butyraceous, volatile oil. The ash amounts to between 1 and 2 
per cent, consisting chiefly of the carbonates of calcium and potas- 
sium. 

Dose of powdered cinchona, 15-60 grains (1.0-4.0 Gm.). 

Official Preparations of Cinchona. 

Extr&ctum Cinchonae — ExtrScti Cinchonae — Extract of Cinchona. — Dose, 5- 
30 grains (0.3-2.0 Gm.). 

Extractum Cinchonae Fluidum — Extraxti Cinchonae Fluidi — Fluid Extract 
of Cinchona. — Dose, 10-60 minims (0.6-4.0 Cc). 

Infusum Cinchonae — Infusi Cinchonae — Infusion of Cinchona (6 per cent.). — 
Dose, 1-4 fluidrachms (4.0-15.0 Cc). 

Tinctura Cinchonae — Tinctiirae Cinchonae — Tincture of Cinchona (20 per 
cent.). — Dose, 1-2 fluidrachms (4.0-8.0 Cc). 



HEMATICS. 223 

Official Preparation of Ci?icho?ia Rubra. 

Tinctura Cinchonae Compflsita— Tincturae Cinchonas Comp6sitae— Com- 
pound Tincture of Cinchona (10 per cent., with Bitter Orange Peel 8 per cent., and 
Serpentaria 2 per cent.). — Dose, 1-4 fluidrachms (4.0-15.0 Cc). 

Official Alkaloids and Salts. 

Cinchonidinae Sulphas— Cinchonidinae Sulphatis— Cinchonidine Sulphate. 
— Description and Properties. — White, silky, acicular crystals, without odor and having 
a very bitter taste; slightly efflorescent on exposure to air. Soluble in 70 parts of water 
and in 66 parts of alcohol. 

Dose. — 10-30 grains (0.6-2.0 Gin.). 

Cinchonina — Cinchoninae — Cinchonine. — Description and Properties. — White 
lustrous prisms or needles, without odor, at first almost tasteless, but soon developing 
a bitter after-taste; permanent in the air; soluble in 3760 parts of water and in 116 
parts of alcohol. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Cinchoninae Sulphas — Cinchoninae Sulphatis — Cinchonine Sulphate. — 
Description and Properties. — Hard, white, lustrous, prismatic crystals, without odor 
and of a very bitter taste; permanent in the air; soluble in 66 parts of water and in 
10 parts of alcohol. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Quinidinae Sulphas — Quinidinae Sulphatis — Quinidine Sulphate. — Descrip- 
tion and Properties. — White silky needles, odorless, and of a very bitter taste; per- 
manent in the air ; soluble in 100 parts of water and in 8 parts of alcohol. It should 
be kept in well-stoppered bottles, in a dark place. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Quinlna — Quininae — Quinine. — Description and Properties. — A white, flaky, 
amorphous or crystalline powder, odorless, and having a very bitter taste ; permanent in 
the air; soluble in 1670 parts of water and in 6 parts of alcohol. Quinine should be 
kept in well-stoppered bottles, in a dark place. 

Dose. — 1-60 grains (0.06-4.0 Gm.). 

Quinlnae Bistilphas — Quinlnae Bisulphatis — Quinine Bisulphate. — Descrip- 
tion and Properties. — Colorless, transparent, or whitish orthorhombic crystals or small 
needles ; odorless and having a very bitter taste ; efflorescent on exposure to the air. 
Soluble in 10 parts of water and in 32 parts of alcohol. It should be kept in well- 
stoppered bottles, in a dark place. 

Dose. — I— 15 grains (0.06-1.0 Gm.). 

Quinlnae Hydrobromas — Quinlnae Hydrobromatis — Quinine Hydrobro- 
mate. — Description and Properties. — White, light, silky needles ; odorless and of a very 
bitter taste. The salt is liable to lose water on exposure to warm or dry air. Soluble 
in 54 parts of water and in 0.6 part of alcohol. It should be kept in well-stoppered 
bottles, in a dark place. 

Dose. — 1-20 grains (0.06-1.3 Gm.). 

Quinlnae Hydrochloras — Quinlnae Hydrochloratis— Quinine Hydrochlorate. 
— Description and Properties. — White, silky, light, and fine needle-shaped crystals, 
odorless, and having a very bitter taste. The salt is liable to lose water on exposure to 
warm air. Soluble in 34 parts of water and in 3 parts of alcohol. Quinine hydro- 
chlorate should be kept in well-stoppered bottles, in a dark place. 

Dose. — 1— 15 grains (0.06-1.0 Gm.). 

Quinlnae Sulphas — Quinlnae Sulphatis — Quinine Sulphate. — Description and 



224 A TEXT-BOOK OF MATERIA MEDICA. 

Properties. — White, silky, light, and fine needle-shaped crystals, fragile and somewhat 
flexible, making a very light and easily compressible mass, lusterless from superficial 
efflorescence after being for some time exposed to the air ; odorless and having a per- 
sistent, very bitter taste. The salt is liable to lose water on exposure to warm air, to 
absorb moisture in damp air, and to become colored by exposure to light. Soluble in 
740 parts of water and in 65 parts of alcohol, also in 40 parts of glycerin and in about 
680 parts of chloroform, and freely soluble in dilute acids. It should be kept in well- 
stoppered bottles, in a dark place. 

Dose. — 1-60 grains (0.06-4.0 Gm.). 

Quininae Valerianas — Quininae Valerianatis — Quinine Valerianate. — 
Description and Properties. — White or nearly white, pearly, lustrous, triclinic crystals, 
having a slight odor of valerianic acid, and a bitter taste ; permanent in the air ; soluble 
in 100 parts of water and in 5 parts of alcohol. It should be kept in well-stoppered 
bottles, in a cool place. 

Dose. — 1-20 grains (0.06-I.3 Gm.). 

Unofficial Alkaloids and Salts. 

Chinoidinum — Chinoidini — Chinoidine. — Origin. — Obtained from the mother- 
liquor in the preparation of quinine sulphate, cinchonine, and the other alkaloids of 
cinchona. 

Description and Properties. — Cylindrical rolls or masses, of a more or less deep- 
brown or black color and a resin-like appearance. It has but a slight taste, being faintly 
bitter on mastication. Almost insoluble in water ; freely soluble in alcohol. 

Dose. — 3-30 grains (0.2-2.0 Gm.). 

Cinchonidinae Salicylas — Cinchonidinae Salicylatis — Cinchonidine Salicy- 
late. — Dose, 2-10 grains (0.12-0.6 Gm.). 

Cinchonina Iodostilphas — Cinchoninse Iodosulphatis — Cinchonine Iodosul- 
phate (Antiseptol) (50 per cent, of iodine). — Description and Properties. — A light 
powder of a reddish-brown color; insoluble in water, but soluble in alcohol. Used 
principally as a substitute for iodoform. 

Chinolin — Chinolin — Chinolin (Quinolin). — Origin. — Prepared from Cincho- 
nine or Quinine by distillation, or obtained synthetically. 

Description and Properties. — A colorless liquid, with an aromatic, pungent odor; 
slightly soluble in water, freely soluble in alcohol. 

Dose. — 3-10 minims (0.18-0.6 Cc). 

Chinolin Tartras — Chinolin Tartratis — Chinolin Tartrate. — Soluble in 70 or 
80 parts of water. Dose, 5-15 grains (0.3-I.0 Gm.). 

Quinetum — Quineti — Quinetum. — A mixture of the alkaloids precipitated by an 
alkali. Dose, 1-60 grains (0.06-4.0 Gm.). 

Quininae Hydrochloras Carbamidata — Quininae Hydrochloratis Carbami- 
datae. — Double salt of Quinine and Urea. Soluble in water. Dose, 1-10 grains (0.06- 
0.6 Gm.). Usually employed hypodermically. 



Antagonists and Incompatibles. — Agents promoting waste — 
such as the salts of mercury, iodine, copper, zinc, and lead — are 
therapeutically antagonistic to cinchona. The cerebral effects of 
quinine are antagonized by morphine, while atropine opposes its 



HEMATICS. 225 

action upon the nervous and circulatory systems, as well as its 
antipyretic powers. 

The incompatibles are free tannic acid, alkalies and alkaline 
earths, and iodine. Fowler's solution is incompatible with infusion 
and decoction of cinchona. 

Synergists. — The Restoratives and all agents promoting con- 
structive metamorphosis. The antipyretic action of quinine is 
enhanced by the antipyretics, salicylic acid, and some of the anti- 
septics. Its antiperiodic action is aided by arsenic, eucalyptus, 
carbolic acid, and creasote. 

The name Cinchona given to Peruvian bark was accorded in 
honor of the countess of Chinchon, cured of tertian fever by the 
use of the drug, as early as the seventeenth century, the Spanish 
conquerors of the country having discerned the curative properties 
of the plant which scientific investigation has rendered invaluable 
as a therapeutic agent. The native Indians had long been ac- 
quainted with its medicinal virtue, and but for the inquisitorial 
bigotry of the age the beneficiary of its potency, upon her 
return to Spain, would have introduced it into Europe. Such, 
however, was the antagonism aroused among an over-zealous 
clergy, and so great the force of professional rivalry, that every- 
where the new discovery encountered opposition, one religious 
body formally spurning it as the invention of unenlightened sav- 
ages, although the countess was not deterred from employing it 
among the peasantry dwelling upon her estates (Markham). 

About the middle of the seventeenth century a large quantity 
of the bark received from America reawakened discussion, and 
finally a council of Jesuits held at Rome approved a distribution 
of the drug — called therefrom " Jesuits' bark." It quickly found 
its way to other parts of the Continent and to England ; yet still 
the opposition to its use was pronounced, and it was only when an 
English quack doctor succeeded in effecting cures among persons 
of rank by an employment of the drug that its services became 
general in malarial and typhoid fevers, as well as in various other 
diseases. 

The discovery of the active principles of cinchona, crudely es- 
tablished by Duncan in 1803, was perfected by Pelletier and Cav- 
entou in 1820 by the preparations of quinine and cinchonine. In 
1833 quinidine became partially known, being completely isolated 
as an active principle in 1852, quinine and cinchonine having been 
employed since 1820-21. 
15 



226 A TEXT-BOOK OF MATERIA MEDICA. 

Until the researches of Marchiafava, Celli, Laveran, Golgi, and 
others had disclosed the true etiology of malaria, quinine was used 
empirically in malarial diseases, its precise action being unknown. 
Its efficacy is now ascertained to be due to its power of destroying 
the plasmodia of malaria. In addition to this action, which ren- 
ders the drug of the greatest value in malarial diseases, quinine 
possesses many other important properties, which are here con- 
sidered. 

Physiological Action. — Externally and Locally. — The drug is a 
potent antiseptic, preventing putrefaction and fermentation by its 
destructive influence upon fungi and infusoria, a solution of I : 250 
being sufficient for this purpose, while 1 : 500 is fatal to certain 
micro-organisms, and even so weak a solution as 1 : 1000 suffices 
to destroy some infusoria. 

Quinine is essentially a protoplasm poison. It affects lower 
animals and plants, interferes, when present, with the normal 
processes of reproduction, affects the blood-cells, and, moreover, 
has a peculiar action in diminishing the activity of many of the 
unorganized ferments. 

Upon the unbroken skin it has little effect, other than to pro- 
duce occasionally a slight roughening of the surface. To raw 
surfaces, however, and to mucous membranes it is irritant. 

Internally. — Digestive System. — Its action resembles that of 
vegetable bitters, augmenting the secretions from the salivary and 
gastro-intestinal glands, stimulating peristalsis, and increasing the 
blood-supply to the stomach. Under moderate doses, therefore, 
the appetite and digestion are improved. Large dosage disturbs 
digestion, occasioning nausea, with, possibly, vomiting and diarrhea. 
The acidity of the stomach is said to be increased by quinine sul- 
phate. 

Circulatory System. — Small doses increase the force and fre- 
quency of the heart's action, excessive doses slowing and weaken- 
ing it, and, frequently in children, causing an intermittent pulse. 
Toxic doses paralyze the heart, arresting it in diastole. It is 
uncertain whether or not these effects are due to an exclusive 
action on the cardiac muscle. It is evident, though, that small 
doses elevate and large doses depress arterial tension. 

Quinine in a remarkable manner affects the constituents of the 
blood. The ameboid movements of the white blood-corpuscles 
are arrested, preventing their migration through the capillary walls 
in inflammation, while their number is diminished by full doses of 



HEMATICS. 227 

the drug both in health and in inflammatory conditions. The red 
corpuscles are relatively increased in number, at least in propor- 
tion to the white corpuscles, the size of the former being dimin- 
ished in febrile conditions. 

Quinine retards or impairs all the oxidizing powers of the body, 
and materially lessens the oxygen-carrying capacity of the red 
corpuscles. This is shown in the diminished metabolism of the 
body. 

Nervous System. — Small doses stimulate the cerebrum. Large 
doses occasion cerebral congestion, with a sensation of dizziness, 
fulness in the head, and other symptoms described at length under 
" Cinchonism." 

In mammals there is a transient stimulation of the spinal cord, 
followed by a depression. In lower animals, notably the frog, 
there is a primary increase in the reflex irritability, which subse- 
quently is followed by depression, perhaps an index of the action 
of the drug on the protoplasm of the ganglionic cells. Muscular 
action is profoundly altered, quinine acting as a poison. Its action 
on sensory and motor nerves is not marked, and depressing effects 
on muscular contraction, formerly attributed to its action on the 
terminal end-plates of the motor nerves, have, of late years, been 
attributed to its action upon the muscle protoplasm itself. 

Respiratory System. — Quinine exerts but little influence upon 
the respiration, small doses slightly increasing and large doses 
depressing the respiratory movements ; death being due to respira- 
tory paralysis, at least in the lower animals. Such paralysis is 
usually accompanied by paralysis of the heart and vagus. When 
toxic doses of quinine are thrown directly into the circulation, 
paralysis of the heart may be primary. 

Absorption and Elimination. — The drug is quite rapidly absorbed 
from the alimentary canal. While its presence may be detected 
in the urine within fifteen minutes after the ingestion of a full dose, 
many hours, or even days, may elapse before the drug is finally 
excreted. 

Some of the drug undergoes a change in the system, especially 
in the liver, and it may be detected in the urine as quinine and 
various isomeric modifications of it. While chiefly eliminated by 
the kidneys, it may escape from the system by other channels, 
having been found in the milk, sweat, saliva, tears, bile, and in 
dropsical effusions. Fully 90 per cent, can be recovered in the 
urine. 



228 A TEXT-BOOK OF MA TERIA MEDICA. 

The excretion of uric acid, urea, and other nitrogenous material 
is considerably diminished under the use of quinine. 

Temperature. — In health the temperature is unaffected by qui- 
nine, but in febrile conditions, particularly in malarial fever, the 
drug acts as a powerful antipyretic. Yet the drug cannot be 
classed as a true antipyretic, since it has not been shown that it has 
any action on the heat-center. It is a matter of clinical observa- 
tion that intermittent, typhoid, and one form of puerperal fever are 
the only diseases which readily yield to the antipyretic influence of 
quinine, the temperature in such maladies as erysipelas, pneu- 
monia, pleurisy, etc. being comparatively unaffected even by large 
dosage, seeming to prove that the drug is an antipyretic only when 
it destroys or renders inert the infective agent producing the fever. 

The action of quinine on temperature is, at best, difficult of 
explanation. Its action in diminishing metabolism may, in part, 
account for some of its effects. 

Eye. — There have been recorded several cases of amblyopia and 
of quinine amaurosis, with transitory blindness, color-blindness, 
wide dilatation of pupils — irresponsive to light, but responding to 
accommodation effort — pallor of the optic disks, with extreme dimi- 
nution of both retinal veins and arteries and contraction of the 
visual field. 

Quinine amaurosis, however, is probably very rare, but a lim- 
ited number of cases being recorded, although Rogers believes 
that " incomplete ocular cinchonism " is of quite frequent occur- 
rence. 

Uterus. — After the inception of labor quinine seems frequently 
to stimulate the uterine contractions. It also increases a scanty 
menstrual flow. There appears to be no authoritative evidence 
that quinine is an abortifacient. 

Untoward Action. — Besides the symptoms of cinchonism from 
which some persons suffer after the ingestion of a small dose, there 
are often occasioned various eruptions of the skin, often accom- 
panied by marked pruritus, the eruption produced by the drug at 
times strongly resembling scarlatina. 

Peculiar disturbances of vision and impaired hearing not infre- 
quently attend the administration of quinine. There have been 
recorded cases of renal and vesical irritation, varying in intensity, 
following the use of the drug. The administration of the salts of 
quinine in pill form is often followed by gastro-intestinal catarrh. 
The drug has also been known to occasion epistaxis and hem- 
optysis. 



HEMATICS. 229 

Poisoning. — Excessive doses of quinine produce a series of 
symptoms collectively termed cinchonism. They are — a feeling of 
fulness in the head, ringing or buzzing in the ears, varying degrees 
of deafness, headache, with possibly delirium, disturbances of 
vision, vertigo, and muscular weakness. Should the dose be lethal, 
there may be marked cardiac and respiratory failure, and collapse. 

Treatment of Poisoning. — Potassium bromide and hydrobromic 
acid are the best agents to relieve the symptoms of cinchonism, 
full doses of the latter given with quinine being said to prevent 
untoward results. 

Should the dose be sufficient to depress the heart and respira- 
tion in a marked degree, cardiac and respiratory stimulants would 
be indicated. 

Therapeutics. — Externally and Locally. — Powdered cinchona 
bark is an ingredient of many tooth-powders. Quinine also enters 
into the composition of many " hair tonics," and is highly recom- 
mended by some physicians in the treatment of alopecia. 

The drug has been employed with varying success in many 
diseases of the nose and throat, such as hay fever, whooping cough, 
ozena, tonsillitis, etc. 

Ledetsch has highly recommended quinine bisulphate, 1 part to 
100 parts of water and glycerin, as an injection in gonorrhea. The 
drug has been used with tincture of ferric chloride as a paint to 
prevent the spread of erysipelas. A 2 per cent, solution has proved 
an efficient remedy in cystitis, effectually preventing the decomposi- 
tion of the urine. 

Internally. — Undoubtedly the principal use of quinine is in the 
treatment of malarial diseases. When we realize that quinine in 
I part to 20,000 is sometimes destructive of the plasmodium mala- 
riae, it is readily understood why the drug should be so efficient as 
an antimalarial remedy. 

Quinine is one of the most powerful antiperiodics, being of 
more or less value in many diseased conditions characterized by 
periodical exacerbations. All forms of malarial fever usually yield 
to the proper use of quinine. It seems to be equally efficient as a 
prophylactic. 

From a practical point of view it is fairly well established that 
at certain phases of development the malarial parasite offers less 
resistance to the action of quinine than at others. Thus, in the 
early stages of the parasite's development the resistance to quinine 
is very marked ; parasitic forms in the second stage, small pigment 



230 A TEXT-BOOK OF MA TERIA MEDIC A. 

masses in the center or at the periphery, offer less resistance, 
higher during the non-febrile stage, much reduced during pyrexia, 
so that the best results are obtained from quinine when adminis- 
tered during the stage of fever or in the period immediately pre- 
ceding. Early doses of quinine check the development of the 
second stage, and prevent, in part at least, the segmentation of the 
parasite. The practical point to be gained from the recent studies 
is that quinine given in the period preceding the. fever and during 
fever is most effective in the cure of the non-pernicious types of 
the disease. 

Many periodical affections due occasionally to malarial organ- 
isms are peculiarly amenable to this drug, among these disorders 
being various neuralgias, headache, asthma, hay fever, chorea, jaun- 
dice % diarrhea, dysentery, etc. 

Quinine is a potent antiphlogistic, being very efficient in check- 
ing inflammation and suppuration. It is particularly beneficial in 
cases of prolonged suppuration, such as pulmonary phthisis , fistu- 
lous discharges, septicemia, pyemia, puerperal fever, etc. It favor- 
ably influences the formative stages of acute inflammations, as in 
the beginning of endocarditis, pneumonia, pleurisy, etc. 

As a tonic or restorative during the course of febrile diseases, 
as well as in convalescence, quinine is highly efficient. Its action 
upon the gastro-intestinal tract renders it valuable in many forms 
of dyspepsia, especially the atonic variety. In these cases, where 
anemia is present, the drug may be advantageously combined with 
iron and nux vomica. 

Quinine is but little used now as a pure antipyretic, being of 
value in this respect, as previously stated, only when it destroys 
the infective cause of the fever. Its antipyretic influence is conse- 
quently more marked in intermittent fever. It is of value also in 
typhoid, although now seldom employed in this disease. 

The remedy has proved efficient in some cases of chorea and 
whooping cough. It is of decided value in the yeasty vomiting pro- 
duced by the sarcina ventriculi, and equally beneficial in impetigo ; 
while acne and ecthyma, when occasioned by reduced vitality and 
impaired nutrition, are greatly benefited by its internal use. 

Quinine is serviceable in stimulating the uterine contractions 
during labor and increasing the menstrual discharge in amenorrhea. 

Contraindications. — The drug is contraindicated in acute in- 
flammations of the genito-urinary and gastro-intestinal tracts, in 
acute or subacute inflammations of the middle ear, and in menin- 
gitis and cerebritis. It should not be given to infants suffering 



HEMATICS. 231 

from eczema, nor to persons having a marked idiosyncrasy against 
the drug. 

Administration. — Because of its intensely bitter and disagree- 
able taste quinine should not be given in solution. It may be sus- 
pended in syrup of yerba santa or in the aromatic elixir of liquorice, 
which disguises the taste quite effectually, and for children is pref- 
erable, as a method of administration, to capsules or pills. In the 
case of adults the drug should be given in gelatin capsules or in 
the form of gelatin- or sugar-coated pills. 

The tannate of quinine is comparatively tasteless, and may be 
incorporated with chocolate in the form of lozenges, thus being 
readily taken by children. 

The drug may be also administered in a suppository by the 
rectum or incorporated in lard and rubbed into the skin, preferably 
in the axillae and the inner side of the thighs or over the abdomen. 
It has been employed to some extent hypodermically, the quinine 
hydrobromate and hydrochlorate being the salts preferred for this 
purpose. Injections should be made in the buttocks, and very 
slowly administered, since this method of administration depresses 
the heart to a considerable degree. 

Occasionally in the treatment of malaria Warburg's tincture, 
containing numerous aromatics, is more efficient than quinine. 

In obstinate malarial affections aromatics and spices greatly 
enhance the effect of quinine, capsicum making one of the best 
adjuvants. The portal circulation is stimulated, rendering the 
absorption of the drug more rapid and its effects more lasting. 

As to the time and method of administration in malarial dis- 
eases, the student is referred to any standard work on the Practice 
of Medicine. 

The various tinctures and elixirs of cinchona are used exten- 
sively ; when employed as stomachics they should be given before 
meals. 

Quinine is best given on an empty stomach or after the active 
process of digestion is completed. 



ANIMAL EXTRACTS (ORGANOTHERAPY). 

The striking fact that various excretions and tissues of the living 
organism, when administered under certain conditions, possess a 
peculiar therapeutic value is now well ascertained. The theory, 
although generally considered an innovation in therapeusis, has 



22)2 A TEXT-BOOK OF MATERIA MEDICA. 

long been the subject of studious attention, yet only in recent years 
has the practical application of organotherapy claimed professional 
recognition and the nature and operation of its curative properties 
acquired unprecedented significance. Extracts derived from almost 
every portion of the human system, together with many animal 
secretions, have been prepared, and their efficacy tested by search- 
ing experiment. It was reserved for the noted investigator Brown- 
Sequard and his associates to inaugurate, as late as 1889, the sys- 
tem of organotherapeusis as known to-day and promulgate the 
theory resulting in the now established medicinal potency of glan- 
dular extracts. 

Among the earliest and most original essays prompted by the 
new procedure was Brown-Sequard's hypodermic injection of an 
extract from the recent testicles of mammals, in the treatment of 
senile debility. It should be noted, in passing, that, curiously 
enough, as there is no new thing under the sun, this special employ- 
ment of organic extract for the relief of morbid conditions finds an 
analogue in a custom of very ancient origin, the high authority of 
Pliny the historian attesting that the Grecian and Roman de- 
bauches were wont to consume the testicles of asses to restore 
their dissipated energies. 

While it must be admitted that the benefits derived from the 
administration of testicular juice have failed to realize the ardent 
anticipations of its earlier advocates, we may cheerfully concede 
that the experimental impetus imparted by it to clinical and thera- 
peutic investigation has added considerably to our scientific knowl- 
edge in the realm of medicine and gone far to alleviate the ills of 
suffering humanity. 

Up to the present time, however, it cannot be stated with posi- 
tiveness that organic extracts derived from the testis, the ovaries, 
or the mammary glands have any marked specific action on the 
respective organs. The excellent results obtained in some cases 
are unquestionably to be attributed to the influence of suggestion. 
More extended study of active principles, should such be found to 
exist per se, is desirable before a final word can be spoken con- 
cerning these extracts. It is more than probable that the many 
spermin, ovarin, etc., preparations on the market owe any supposed 
activity to the influences of suggestion. 

Numerous chemical studies made during the past few years have 
seemed to show that the action of the thyroid extract is due to a 
peculiar body rich in iodine. It is found principally in the colloid 



ANIMAL EXTRACTS. 



233 



substance of the gland, and is rich in globulin, a thyreoglobulin 
from which a principle, iodothyrin, has been isolated. Although 
much remains to be learned concerning this iodothyrin, it is safe to 
assume it as the active principle of the gland. It varies greatly in 
amount in different glands and at different ages in the human subject. 

The most rational and successful application of organotherapy, 
perhaps, was that of Murray in 1891, who proposed the subcuta- 
neous injection of a thyroid extract in the treatment of myxedema, 
many cases of which have improved, while others have been defin- 
itely cured by the adoption of the remedy. The preparations in 
this case have included the ingestion of the dry powder, the injec- 
tion of a glycerin extract, and the raw or partially cooked gland 
administered as food. The testimony of competent authorities 
amply attests the efficacy of the agent, which now receives almost 
universal acceptance. 

Action. — If injected into the veins of animals, iodothyrin causes 
an acceleration of the heart action, lowers the blood pressure, 
increases the amount of urine excreted, and may give rise to dysp- 
nea and diarrhea. It seems probable that many of the peculiar 
toxic symptoms that were observed when the older extracts were 
in use were in reality due to the presence of putrefactive ptomains. 
In large doses, in man, symptoms somewhat similar to those ob- 
served in exophthalmic goiter have been reported. Iodothyrin has 
also the effect of increasing catabolism and produces a marked 
breaking down of proteids, in this way causing loss of flesh. 
This effect, combined with its diuretic action, renders it valu- 
able in the treatment of obesity. 

Prof. Wood lucidly summarizes our present knowledge of the 
physiological action and therapeutic value of this preparation : " In 
hypertrophy of cicatricial tissue resembling keloid, possibly true 
keloid, thyroid extract has caused absorption of the hypertrophied 
and cicatricial tissue. It has been used with success in simple goiter ; 
in the goiter of Switzerland, before calcareous degeneration has 
taken place, it will bring about destruction and absorption of the 
overgrown tissue. In excessive obesity with tendency to weakness 
and anemia, in which exercise and diet fail, thyroid extract should 
be tried. It is sometimes useful in melancholia, but how it acts we 
do not know. When thyroid extract is used freely in continuing 
doses it sometimes produces a series of phenomena constituting 
so-called 'thyroidism.' The most important of the symptoms are 
loss of weight, shortness of breath, and a weak and rapid pulse. In 



234 A TEXT-BOOK OF MATERIA MEDICA. 

all cases in which the extract is being used freely and continuously, 
but especially in those cases in which the symptoms are not those 
of myxedema, the patient should be weighed every two weeks, and 
any undue loss of weight or disturbance of circulation or respira- 
tion should be the immediate signal for the withdrawal of the 
remedy or a great reduction of the dose. The thyroid extract 
has been largely used in exophthalmic goiter ; but here, I am sure, 
it does harm. The cause of the symptoms in exophthalmic goiter 
is undoubtedly the excessive development of the thyroid secre- 
tion." 

With regard to the therapy of the various glandular extracts 
much has been written, and concerning the practical efficacy of 
certain preparations contending opinions prevail. The list of con- 
ditions in the treatment of which they have proved more or less 
favorable is a long one, including cancer, chorea, nervous conditions, 
such as neurasthenia, sexual atony, several forms of hysteria, 
together with systemic disorders, such as profound anemia, chlorosis, 
or chloro-anemia, associated with dysmenorrhea, osteomalacia, while, 
besides myxedema and exophthalmic goiter, fibroid tumors of the 
uterus, and inoperable carcinomata of the breast, uterus, and vagina 
have been materially improved, if we may believe the reports of 
trustworthy observers. Perhaps the latest application of thyroid is 
its use in cerebral neoplasms. 

The following resume is of interest : 

" With the treatment of myxedema, cretinism, Basedow's dis- 
ease, lipomatosis universalis, cachexia strumipriva, and insanity, it 
would seem as if the use of thyroid had reached its limitations. 
The successful administrations and beneficial results obtained in 
some of the above diseases, however, have stimulated many observ- 
ers and experimenters to make a wider trial of this form of medi- 
cation, with the result that hardly a week passes by without an 
attempt being recorded to extend its field of usefulness. Thus we 
find Hertoghe advocating the use of thyroid as a galactagogue, and 
his good results have been corroborated by Stawell. 

" The dosage, method of administration, and danger-signals are 
no less important than the indications for its use. The hypodermic 
administration of the liquid extract and the grafting of the fresh 
gland have long fallen into disuse, and the tendency of the present 
day is to administer the powder or to give tablets or capsules pre- 
pared from the desiccated fresh gland. The dose varies with the 
individual, and for this reason it is advisable to begin with small 
doses, which should be gradually increased until the desired effect 



ANIMAL EXTRACTS. 235 

is produced. Beginning with one or two grains a day, as much as 
fifteen grains may be administered, the prescriber always being on 
the qui vive for poisonous symptoms. During the course of ad- 
ministration especial attention should be given to the respiratory 
and cardiac apparatus, and at the first appearance of rapid pulse, 
embarrassed respiration, rise of temperature, vertigo, or gastric dis- 
turbance, its use should be abandoned. 

Improvement has been noted in several cases of malignant 
syphilis, Menzies considering that thyroid acts as a powerful skin- 
tonic and a useful adjuvant to mercury and potassium iodide in the 
treatment of this disease. 

The favorable results often attending the partial employment of 
animal agents in diseases of corresponding organs, and especially 
the noteworthy benefits derived from the application of the thyroid 
treatment in myxedema, have suggested the preparation of many 
extracts of varying efficacy. 

Suprarenal Gland. — This gland also contains an active con- 
stituent, first isolated by Abel and Crawford, and termed by them 
epinephrine, and supplied by manufacturers as adrenalin. The 
chemical composition of this body is complex, but in many particu- 
lars it resembles some of the vegetable alkaloids, notably some of 
the pyridin group. 

Epinephrin itself is so unstable that it has not been possible to 
give it a satisfactory description. Its salts, sulphates, and hydro- 
chlorides are more satisfactory. The sulphate is a hygroscopic, 
straw-colored residue, which tends to crystallize on standing over 
sulphuric acid. Agglomerated groups of small crystals form on 
the edge of the receptacle, and the entire residue takes on a semi- 
crystalline appearance. The adrenalin hydrochloride is a more 
stable compound. 

Physiological Action. — With aqueous solutions of fresh speci- 
mens of the dried gland or with solutions of the salts this drug has 
a marked action on mucous membranes. A few drops of the 
solution act as a rapid and strong astringent, whitening the mucous 
membrane by stimulating the contractile muscles of the blood- 
vessels. This action is local, and is manifest in the mucous mem- 
branes of the conjunctivae, nares, pharynx, membrana tympani, 
vagina, urethra, and rectum. The parts to which it is applied are 
rendered practically bloodless. This action persists for from fifteen 
minutes to half an hour following a single application. Repeated 
applications do not seem to cause paralysis of the blood-vessels. 



236 A TEXT-BOOK OF MATERIA MEDICA. 

When administered by the mouth, some of the systemic effects 
of the drug may be developed, but it is by subcutaneous injection 
or intravenous infusion that the systemic effects are brought out. 
In general, these resemble those produced by the glycosides of 
the digitalis group. The heart action is rendered more forcible by 
direct muscular stimulation ; the rate is decreased by stimulation 
of the vagus centers ; and there is a very rapid and extreme rise 
in the blood pressure, due to at least three elements — the strength- 
ening of the heart's contractions, marked general direct contraction 
of the muscular fibers, and a stimulation of the vasomotor centers. 

Its action on other portions of the body has not been determined 
with accuracy for man. In lower animals — frogs — paralysis of the 
central nervous system has been produced ; in dogs and rabbits 
large doses administered subcutaneously have caused nervous 
excitability, muscular tremors, at times nausea, followed by paresis 
of the hind limbs, rapid respiration, dyspnea, and death. 

Observations concerning its action on other portions of the 
anatomy are as yet fragmentary. 

Therapy. — This is still in its infancy. 

The suprarenal extract should be freshly prepared, its active 
principle being weakened by heat and preservation. It is the most 
powerful astringent known, a single drop of a 1 per cent, solution 
instilled into the eye resulting in a whitening of the conjunctiva 
and lids in from two seconds to forty minutes. It is useful in all 
forms of inflammation of the eye, whether traumatic, infectious, or 
proceeding from constitutional diseases, such as rheumatism, 
syphilis, or tuberculosis. The pupil is not contracted by it, and 
tolerance is not established by its use. It possesses neither anti- 
septic nor anesthetic properties, the rapid cures attending its em- 
ployment being entirely due to its wonderfully astringent influence. 

In suppurative otitis and dry catarrh the extract is often valuable 
in relieving congestion. By it tinnitus is permanently relieved. It 
lessens the congestion of turbinated bodies immediately, often ben- 
efiting catarrhal affections when cocaine and other astringents fail. 
It reduces the congestion of an inflamed eye sufficiently to permit 
cocaine anesthesia. It has been found efficacious in relieving vari- 
ous strictures, as of the nasal duct, the urethra, and the esophagus. 

Velich found that the extract occasions local anemia when ap- 
plied to the skin, not only where there is a lesion, but also where 
the cuticle is unbroken. It has been used to whiten an eczema- 
tous patch and to prevent vesiculation, while compresses saturated 
with the extract have dispelled hyperemia in cases of vertigo. Dr. 



ANIMAL EXTRACTS. 237 

Douglas Stanley found that in one case of pernicious anemia the 
freshly prepared aqueous extract produced a marked increase in 
the number of red corpuscles. It is valuable in Addison's disease 
(Osier), and is a tonic to the heart-muscles (Oliver and Schafer), 
"the tension being enormously increased by intravenous injec- 
tions," though its action is less marked in subcutaneous use, and 
is uncertain when administered per os. It is much more powerful 
than either digitalis or ergot. 

Its field of usefulness as a local astringent has not yet been fully 
explored. In nasal operations it renders the field of operation 
bloodless, and there is no reason why it cannot be used, when 
rendered aseptic, in abdominal or brain surgery, especially where 
continuous oozing is a bar to good technic. 

The field for its systemic use will probably widen. It is a pow- 
erful heart tonic, and is particularly to be recommended in poison- 
ing by those drugs that cause vasomotor paralysis, notably chloro- 
form and chloral, and in threatened heart failure its use is to be 
commended. Addison's disease, confessedly related to the supra- 
renal gland in some obscure manner, may in time be benefited by 
its use, but as yet no markedly encouraging progress has been 
made in this direction. 

Thymus Gland. — This organ contains bodies rich in iodine 
similar to those found in the thyroid, but as yet no therapeutic 
application has been followed by marked success. 

Pituitary Body. — Inasmuch as acromegaly has been found to 
be associated constantly with disease of the pituitary body, it has 
been suggested that this body might be of some service, but thus 
far success in its use for this disease has been only hypothetical. 
The gland is a complex structure anatomically, and further research 
may give some results. 

Nuclein. — In 1894, Professor V. Vaughan, of the University of 
Michigan, read a paper before the Illinois State Medical Associa- 
tion, giving the results of numerous experiments made by himself 
and Dr. McClintock with nuclein. 

Nuclein is a complex proteid body, characterized by its large 
percentage of phosphorus. It is that constituent of a cell by vir- 
tue of which the histologic unit grows, develops, and reproduces 
itself; it is the function of the nuclein to utilize the pabulum within 
its reach ; it is by the action of their nuclein that cells of various 
organs and organisms possess and manifest their individual charac- 
teristics. It is sometimes called chromatin on account of the readi- 
ness with which it absorbs and holds coloring-agents. The chro- 



238 A TEXT-BOOK OF MATERIA MEDICA. 

matic difference in the nucleins of various cells is an aid to their 
identification under the microscope. 

The phosphorus exists in the form of nucleinic acid ; so far as 
is known, this acid is the same in all cells, yet the basic part differs 
in various nucleins. Most of the experiments of Vaughan and 
McClintock, as well as those of nearly all others, have been made 
with the yeast nuclein ; that cell is particularly rich in nucleinic 
acid, easily obtained free from contamination. 

When administered hypodermatically or orally, nuclein increases 
the number of leukocytes in about three hours. The amount of 
increase varies with the subject ; it may be slight or it may be three- 
fold ; it occurs principally in the polynuclear cells. Metschnikoff 
has shown that these cells are the most active of the phagocytes. 

Hans Buchner has demonstrated that the blood-serum, freed from 
corpuscular elements, is bactericidal. This bactericidal potency is 
due to nuclein, found free in the blood and probably secreted by 
the leukocytes. Hahn of Munich has made experiments with se- 
rum upon the staphylococcus pyogenes aureus and the bacillus 
coli communis, showing that the administration of yeast nuclein 
Increased this germicidal power several fold. The effects of nu- 
clein pass away in about forty-eight hours. 

Nuclein is of great value in conditions of infection where the 
symptoms are due to general invasion of the bacteria. Favorable 
results are obtained in simple anemias. It is found on the market 
in a 5 per cent, solution, dose 1 to 2 drachms. It should be given 
on an empty stomach. Vaughan reports that in tuberculosis the 
effect of moderate injections has been to lower the temperature, 
without untoward manifestations. Indolent ulcer has yielded com- 
pletely to a similar treatment. 

It is also stated upon high authority that the remedy is useful 
in " all forms of anemia, in chronic and recurrent malaria, in diges- 
tive disorders, and in acute and chronic pulmonary affections''' 
(Aulde), the nuclein adopted being obtained from the thyroid and 
thymus glands. The latter author suggests the use of nuclein in 
the treatment of typhoid, in which disease the activity of leucocy- 
tosis is defective. 

Bone-marrow has proved efficacious in anemia (Dickson, 
Frazer), and has also been employed by Filleau in tuberculosis. 

Pancreas Extracts. — These have been employed in diabetes, 
but as yet very crudely and with no effect. 

Careful technic is desirable in the use of this class of bodies, 
and their further study may be crowned with brilliant success. 



DIVISION II.— ALTERATIVES. 



These drugs are unnatural to the system, though acting spe- 
cifically, and in some unknown way, against certain diseases or 
morbid conditions. They are given with a view to influencing the 
course of the disease itself, not for their effect upon the symptoms 
alone. If administered for any length of time, there is danger of 
poisoning, because of the characteristic action of these medicines, 
which differs essentially from their remedial influence. 

When used as alteratives they do not produce or relieve symp- 
toms, except by renewal of health or by removing either the 
pathological condition or the disease. Whenever, therefore, these 
drugs produce symptoms when used specifically, it is a sign that 
they are contraindicated, or have been given for too long a time, 
or in too large doses. As they are unnatural, and consequently 
more or less poisonous to the system, their administration should 
be accompanied by restoratives to lessen their tendency to unto- 
ward manifestations and systemic depression. 

Mercury, being perhaps the most typical alterative, will be first 
considered. 

Hydrargyrum— Hydrargyri— Mercury. U. S. P. 

(Quicksilver.) 

Origin. — The knowledge of this drug antedates the Christian 
era. It is found in Spain, Austria, Peru, and China, but is obtained 
principally from New Almaden, California. It occurs to some ex- 
tent in the metallic state in the form of minute or large globules ; 
also in combination with oxygen, chlorine, selenium, etc. ; but the 
principal ore from which it is extracted is cinnabar. 

Description and Properties. — A shining, silver-white metal, 
without odor or taste. It is liquid at the ordinary temperature, 
and easily divisible into spherical globules ; but when cooled to 
— 39.38 C. (—38.88° F.), it forms a ductile, malleable mass. 
Specific gravity, 13.5584 at 15° C. (59° R). 

Insoluble in the ordinary solvents, also in concentrated hydro- 
chloric acid, and, at common temperatures, in sulphuric acid, but 
dissolving in the latter when boiled with it, and readily and com- 
pletely soluble in nitric acid. Mercury should be kept in strong, 
well-stoppered bottles. 

239 



240 A TEXT-BOOK OF MATERIA MEDICA. 

Dose. — Mercury is seldom given internally except in the modi- 
fied form of blue pill. 

Hydrargyrum Ammoniatum— Hydrargyri Ammo- 
niati— Ammoniated Mercury. TI, S. IP, 

Origin. — Prepared by mixing solutions of Ammonia and Cor- 
rosive Mercuric Chloride. Filter and wash the precipitated am- 
moniated mercury. 

Description and Properties. — White, pulverulent pieces, or 
white, amorphous powder, without odor, and having an earthy, 
and afterward styptic and metallic taste. Permanent in the air. 
Almost insoluble in water or in alcohol. It should be kept in well- 
stoppered bottles, protected from the light. Used externally. 

Official Preparation. 

UnguSntum Hydrargyri Ammoniati — UnguSnti Hydrargyri Ammoniati — 
Ointment of Ammoniated Mercury. — Formula: Ammoniated Mercury, 10; Ben- 
zoinated Lard, 90 parts. For external use. 

Hydrargyrum cum Creta— Hydrargyri cum Creta— 
Mercury with Chalk, tf. S. B. 

Origin. — Obtained by trituration of Mercury, Prepared Chalk, 
Clarified Honey, and Water. 

Description and Properties. — A light gray, rather damp pow- 
der, free from grittiness, without odor, and having a slightly sweet- 
ish taste. It contains 38 per cent, of mercury. This preparation 
should be kept in well-stoppered bottles, protected from light. 

Dose. — 3-10 grains (0.18-0.6 Gm.). 

Massa Hydrargyri— Massae Hydrargyri— Mass of 
Mercury. U.S.JP. 

(Pilula Hydrargyri — Blue Mass — Blue Pill.) 
Composed of Mercury, Glycyrrhiza, Althaea, Glycerin, and 
Honey of Rose. 

Dose. — i-10 grains (0.03-0.6 Gm.). 

Unguentum Hydrargyri — Unguenti Hydrargyri — 
Mercurial Ointment. U. S. jP. 

(Blue Ointment.) 
Composition : Mercury, Lard, Suet, and Oleate of Mercury. 
Used externally. 



AL TERA TI VES. 241 

Emplastrum Ammoniaci cum Hydrargyro— Em- 
plastrum (ace.) Ammoniaci cum Hydrargyro- 
Ammoniac Plaster with Mercury. V. 8. JP. 

Composition : Ammoniac, Mercury, Oleate of Mercury, Diluted 
Acetic Acid, and Lead Plaster. Used externally. 

Emplastrum Hydrargyri— Emplastri Hydrargyri— 
Mercurial Plaster. U. S. ~P. 

Composition : Mercury, Oleate of Mercury, and Lead Plaster. 
Used externally. 

Hydrargyri Chloridum CorrosTvum — Hydrargyri 
Chloridi Corroslvi— Corrosive Mercuric Chloride. 
U. S. JP. 

(Corrosive Chloride of Mercury — Corrosive Sublimate.) 

Origin. — Prepared by heating a mixture of Mercuric Sulphate, 
Sodium Chlorate, and Manganese Dioxide. The corrosive chloride 
sublimes and is condensed. 

Description and Properties. — Heavy, colorless, rhombic crys- 
tals or crystalline masses ; odorless and having an acrid and per- 
sistent metallic taste. Permanent in the air. Soluble in 16 parts 
of water, in 3 parts of alcohol, in 2 parts of boiling water, in 1.2 
parts of boiling alcohol, in 4 parts of ether, and in about 14 parts 
of glycerin. It should be kept in well-stoppered bottles. 

Dose. — ^[grain (0.001-0.008 Gm.). 

Hydrargyri Chloridum Mite — Hydrargyri Chloridi 
MItis— Mild Mercurous Chloride. U. S. JP. 

(Calomel — Mild Chloride of Mercury.) 

Origin. — Obtained by triturating Mercuric Sulphate, Mercury, 
Sodium Chloride, and boiling Distilled Water. Sublime, and wash 
the sublimed calomel with boiling distilled water. 

Description and Properties. — A white, impalpable powder, be- 
coming yellowish-white on being triturated with strong pressure. 
It is odorless and tasteless, and permanent in the air. Insoluble in 
water, alcohol, or ether, and also in cold, diluted acids. When 
strongly heated it is wholly volatilized, without melting. Calomel 
should be kept in dark, amber-colored bottles. 

Dose. — ^2~io grains (0.002-0.6 Gm.). 

Calomel enters into the following 

16 



242 A TEXT-BOOK OF MA TERIA MEDICA. 

Official Preparations. 

Pllulae Antimdnii CompSsitse — Pilulas (ace.) Antimonii Comp6sitas — Com- 
pound Pills of Antimony. — Dose, i or 2 pills. 

Pilulae CathSrticae Compositae — Pilulas (ace.) Catharticas CompSsitas— . 
Compound Cathartic Pills. — Dose, 1 to 3 pills. 

Hydrargyri Cyanidum— Hydrargyri Cyan idi— Mer- 
curic Cyanide. TI. S. JP. 

Origin. — It may be obtained by boiling pure Ferrocyanide of 
Iron with Mercuric Oxide ; the mercuric cyanide, entering into 
solution, is separated by filtration, evaporization, and crystallization 
from diluted alcohol. 

Description and Properties. — Colorless or white prismatic 
crystals ; odorless, and having a bitter, metallic taste (the salt is 
exceedingly poisonous), becoming dark-colored on exposure to 
light. Soluble in 12.8 parts of water and in 15 parts of alcohol. 

Pose. — r^o~TB" g ra i n (0.0006-0.004 Gm.). 

Hydrargyri Iodidum Flavum— Hydrargyri Iodidi 
Flavi— Yellow Mercurous Iodide. U.S.I*. 

(Hydrargyri Iodidum Viride — Protiodide of Mercury — Yellow (or Green) 

Iodide of Mercury.) 

Origin. — Prepared by mixing solutions of Potassium Iodide 
and Mercurous Nitrate with Nitric Acid and Distilled Water. 
The precipitate is washed and dried. 

Description and Properties. — A bright yellow amorphous 
powder, odorless and tasteless. By exposure to light it becomes 
darker in proportion as it undergoes decomposition into metallic 
mercury and mercuric iodide. Almost insoluble in water, and 
wholly insoluble in alcohol or ether. It should be kept in dark, 
amber-colored vials, with the least possible exposure to light. 

Dose. — J— \ grain (0.01-0.03 Gm.). 

Hydrargyri I5didum Rubrum-Hydrargyri Iodidi 
RGbri— Red Mercuric Iodide. TJ. S. P. 

(Biniodide of Mercury — Red Iodide of Mercury.) 

Origin. — Prepared by mixing solutions of Corrosive Mercuric 
Chloride and Potassium Iodide ; filter, and dry the precipitated red 
iodide. 

Description and Properties. — A scarlet-red, amorphous pow- 
der, odorless and tasteless ; permanent in the air. Almost insoluble 



AL TERA TI VES. 243 

in water, but soluble in 130 parts of alcohol. It should be kept in 
well-stoppered bottles, protected from light. 

Dose. — 3V" A" g ram (0.002-0.004 Gm.). 

This drug enters into the 

Official Preparation. 

Liquor Arseni et Hydr&rgyri Iodidi — Liquoris Arseni et Hydr3rgyri Iodidi 
— Solution of Arsenic and Mercuric Iodide. — (Described under Arsenic.) — Dose, 
5 minims (0.3 Cc.), gradually increased. 

Hydrargyri Oxidum Flavum— Hydrargyri Oxidi 
Flavi— Yellow Mercuric Oxide. TI. S. ~P. 

Origin. — Prepared by precipitating a solution of Corrosive 
Mercuric Chloride with Soda. 

Description and Properties. — A light orange-yellow, amor- 
phous, heavy, impalpable powder ; odorless, and having a some- 
what metallic taste. Permanent in the air, but turning darker on 
exposure to light. Almost insoluble in water or in alcohol. It 
should be kept in well-stoppered bottles, protected from light. 
Not used internally. 

Official Preparation. 

UnguSntum Hydr^rgyri Oxidi Flavi — Ungu&nti HydrSrgyri Oxidi Flavi — 
Ointment of Yellow Mercuric Oxide. — Formula: Yellow Mercuric Oxide, 10; 
Ointment, 90 parts. Used externally. 

Hydrargyri Oxidum Rubrum— Hydrargyri Oxidi 
Rubri— Red Mercuric Oxide. TI. S. P. 

(Red Precipitate.) 

Origin. — Prepared by dissolving Mercury in Diluted Nitric 
Acid. Evaporate to dryness. Triturate the mercuric nitrate thus 
formed with mercury and heat. 

Description and Properties. — Heavy, orange-red crystalline 
scales, or a crystalline powder, becoming yellower the finer it is 
divided ; odorless, and having a somewhat metallic taste ; perma- 
nent in the air. Almost insoluble in water and in alcohol. It 
should be kept in well-stoppered bottles, protected from light. 

Dose. — 64 - iV grain (0.001-0.006 Gm.). 

Official Preparation. 

UnguSntum Hydrargyri Oxidi Rubri — Ungu6nti Hydrargyri Oxidi Rubri 
— Ointment of Red Mercuric Oxide. — Formula: Red Mercuric Oxide, 10; Castoi 
Oil, 5; Ointment, 85 parts. Used externally. 



244 A TEXT-BOOK OF MATERIA MEDICA. 

Hydrargyri Subsulphas Flavus— Hydrargyri Sub- 
sulphatis Flavi— Yellow Mercuric Subsulphate. 

U. S. JP. 

(Basic Mercuric Sulphate — Turpeth Mineral.) 

Origin. — Obtained by dissolving Mercury in Sulphuric and 
Nitric Acids. Add a sufficient quantity of Water. Decant and 
dry the residue. 

Description and Properties. — A heavy, lemon-yellow powder, 
odorless and almost tasteless ; permanent in the air. Soluble in 
about 2000 parts of water. Insoluble in alcohol. It should be 
kept in well-stoppered bottles, protected from the light. 

Dose. — J- 3 grains (0.015-0. 18 Gm.). 

Liquor Hydrargyri Nitratis— Liquoris Hydrargyri 
Nitratis— Solution of Mercuric Nitrate. U. S. P. 

A liquid containing about 60 per cent, of Mercuric Nitrate, 
together with about 1 1 per cent, of free Nitric Acid. 

Description and Properties. — A clear, nearly colorless, heavy 
liquid, having a faint odor of nitric acid and a strongly acid reac- 
tion. The product should be kept in glass-stoppered bottles. 

Used externally as a caustic. 



Unguentum Hydrargyri Nitratis — Unguenti Hy- 
drargyri Nitratis— Ointment of Mercuric Nitrate. 
U. S. JP. 

(Citrine Ointment.) 

Formula: Mercury, 70; Nitric Acid, 157; Lard Oil, 760 parts. 
Used externally. 

Unofficial Preparations. 

Hydrargyri Salicylas — Hydrargyri Salicylatis — Mercurous Salicylate. — 

Dose of Mercurous Salicylate, \-\ grain (0.008-0.015 Gm.). — Dose of Mercuric Salicy- 
late, -^-\ grain (0.004-0.008 Gm.). 

Hydrargyri Formamidatum — Hydrargyri Formamidati — Formamidate of 
Mercury. — Dose for hypodermic use, ^-\ grain (0.005-0.01 Gm.). 

Hydrargyri T&nnas — Hydrargyri Tannatis — Mercurous Tannate. — Dose, 
i-l grain (0.03-0.06 Gm.). 

Lotio Flava — Lotionis Flavse — Yellow Wash. — Corrosive Sublimate, 25 grains 
(1.5 Gm.), in Lime Water, 16 ounces (473.17 Cc.). For external use. 

Lotio Nigra — Lotionis Nigrse — Black Wash. — Calomel, 64 grains (4.15 Gm.), 
in Lime Water, 16 ounces (473.17 Cc). For external use. 

Asparagin Hydrargyrate. — Dose, \ grain (0.01 Gm.), hypodermically. 



ALTERATIVES. 245 

Antagonists and Incompatibles. — Mercury with chalk is in- 
compatible with acids and acidulous salts. Calomel is incompatible 
with alkalies, alkaline earths, alkaline carbonates, iron, lead, copper, 
iodine, bromides, soaps, sulphydrates, and nitrohydrochloric acid, 
as well as hydrochloric acid, potassium, ammonium, and sodium 
chloride. 

Corrosive sublimate is incompatible with alkalies and their car- 
bonates, soap, lime water, tartar emetic, the iodides of potassium 
and sodium, acetate of lead, silver nitrate, the sulphides, albuminous 
liquids (as milk, etc.), many vegetable infusions, and compound 
syrup of sarsaparilla. 

In general, metallic preparations of mercury are incompatible 
with iodine and the chlorides. 

Synergists. — Potassium iodide enhances the antisyphilitic action 
of mercury. Depressants — such as antimony and alkalies — increase 
the physiological activity of mercury and its preparations. 

Tonic and resin-bearing purgatives — such as aloes, rhubarb, 
and podophyllum — aid the cathartic action of some of the mercurial 
preparations. 

Physiological Action. — Externally and Locally. — Most of the 
preparations applied to the skin are antiparasitic and antiseptic, 
corrosive mercuric chloride being one of the most important anti- 
septics and universal germicides known. 

Some of the mercurials are powerful irritants, the nitrate being 
an active caustic The mercurous salts, even, possess slightly 
stimulating properties. 

Metallic mercury and its salts are readily absorbed with the aid 
of friction, at times producing a slight irritation resulting from their 
stimulating properties. Absorption may also take place from local 
application in the form of a fine vapor. 

The introduction of the drug into the system through the 
medium of the skin is attended with all the symptoms of mercurial 
poisoning. The local actions of the various preparations differ 
somewhat, yet they agree in certain physiological effects produced 
after absorption of the drug. 

A common feature of mercurial application is a slight, peculiar 
fetor in the mouth, accompanied by soreness of the teeth, swelling 
of the gums, and an increase of saliva, ptyalism being a marked 
symptom of mercurial disturbance. A disagreeable metallic taste 
is seldom absent. These symptoms assume a serious phase if the 



246 A TEXT-BOOK OF MATERIA MEDICA. 

application be continued, stomatitis and other graver conditions 
ensuing. 

Internally. — Digestive System. — Small doses have little untoward 
effect ; they may even prove tonic. Large doses act unfavorably 
upon the gastro-intestinal mucous membrane, causing diarrhea and 
possibly more serious derangement. As purgatives the mercurial 
preparations act by augmenting the secretions of the intestinal 
glands ; at the same time the pancreatic secretions are increased 
and there is marked activity of the absorbent system. The prin- 
cipal action is on the duodenum, hastening evacuation of the bile 
and preventing its reabsorption. While promoting excretion of 
bile, they act the reverse as to its secretion. This is particularly 
true of calomel, which actually diminishes that secretion, though 
it is alleged that the corrosive mercuric chloride is a direct cho.la- 
gogue, stimulating to some extent the hepatic secretory apparatus. 

Circulatory System. — Corrosive sublimate exerts a decided in- 
fluence upon the heart, its toxic effect tending to diminish cardiac 
action. The remaining preparations of mercury appear to be less 
active in this respect. The physical action of the drug upon the 
corpuscular constituents of the blood has been well ascertained, 
anemia, reduced cohesion, and final dissolution having been ob- 
served. It is to be noted that under prolonged or over-dosage 
the blood becomes impoverished, its ozonizing function is impaired, 
and the fibrin loses its coagulability. But when administered in 
minute doses the mercuric corrosive chloride acts as a tonic to the 
blood, increasing the number of red corpuscles and the body- 
weight. 

Should " tonic doses " be continued for too long a period, there 
would be increased weight, owing to too great stimulation of the 
lymphatic system. 

Nervous System. — The full effects of mercury and its prepara- 
tions upon the nervous system are best seen when toxic doses 
are given. The effects are considered in exte?tso under the head 
of " Poisoning." In small doses the tonic effects are present. 

Respiratory System. — The general tendency of mercury, in those 
who have been subject to prolonged dosage, is to depress the cir- 
culation, rendering the breathing labored and debilitated, a sense 
of respiratory constriction being present. 

Absorption and Elimination. — When a preparation of mercury 
is taken internally it is converted in the stomach into a double 
chloride of sodium and mercury. This substance, uniting with the 
albuminous juices, is soluble in an excess of albumin and sodium 



ALTERATIVES. 247 

chloride, and, readily diffusing into the blood, is converted into, 
and exists in that fluid as, the oxyalbuminate of mercury. 

The absorption of this drug is gradual, yet, notwithstanding 
every secretion of the body contributes to its general expulsion 
from the system, its cumulative action is a well-established fact. 
Elimination occurs chiefly by the urine, the saliva, bile, sweat, milk, 
and feces. Even the semen shares in the process. Single doses 
may be eliminated in twenty-four hours, but the drug has been 
detected in the liver a year after the discontinuance of prolonged 
treatment. 

Mercury has been found in serum and in pus from ulcers. 

Calomel possesses marked diuretic action, greatly increasing the 
amount of urine. This is probably due to its direct stimulating 
effect on the renal epithelium. In poisoning by corrosive subli- 
mate, or even when calomel is given for a long time, irritation of 
the renal epithelium takes place, which may go on to necrosis and 
death of these structures. 

Temperature. — Save in a secondary manner, temperature is sel- 
dom affected. From over-stimulation or irritation the drug may 
produce local inflammatory conditions or even febrile symptoms. 

Eye. — Himly mentions that amaurosis mercurialis occurs in 
workers in mercury, while Galezowski reports an example of optic 
atrophy, and Square cites a case of optic neuritis, due to the toxic 
action of mercurial salts. 

Untoward Action. — Many affections of the skin manifest them- 
selves after the exhibition of mercury, erythema and eczema (eczema 
mercuriale) frequently occurring after either the ingestion or the 
external application of mercurial preparations. 

The author recalls one patient in whom \ grain (0.016 Gm.) of 
calomel excited an exanthematous eruption over the entire body, 
some edema of the face, together with fever and angina of the 
fauces. At another time similar symptoms were produced in this 
patient by immersing the hands in a 1 : 2000 solution of corrosive 
sublimate. 

In certain persons having an idiosyncrasy regarding this drug 
extreme salivation and stomatitis may be induced by the internal 
use or the external application of mercurial preparations in medici- 
nal quantities. 

Medicinal doses may produce, in susceptible persons, marked 
disturbances of nutrition, sensation, and motion to such a degree 
as to suggest poisoning. 

Poisoning. — Although mercury in a metallic state is com para- 



248 A TEXT-BOOK OF MA TERIA MEDIC A. 

tively innocuous, its vapor is capable of producing violent and 
dangerous symptoms. All the salts are active poisons, especially 
that known as corrosive sublimate. The symptoms following toxic 
doses of this preparation resemble those occasioned by arsenic. 
The salt, however, being more readily soluble, produces propor- 
tionately more speedy and pronounced effects. They are, briefly, 
a strong, metallic taste in the mouth, frequent and bloody evacua- 
tions, tenesmus, severe abdominal pains, vomiting, and labored res- 
piration. There may be suppression of urine, syncope, and perhaps 
insensibility and convulsions. 

One of the most obstinate features of mercurial poisoning is 
ptyalism or salivation. This condition is first manifested by tender- 
ness of the gums and teeth. The gums are inflamed and covered 
by a white, sticky substance, and bleed at the slightest provocation. 
The breath is very offensive. The teeth become loose, and may 
drop out. Necrosis of the maxillary bones may appear, and ex- 
tensive ulcerations of the gums and cheeks frequently occur. 
Accompanying these manifestations is an enormous increase in the 
amount of saliva secreted, which in some instances literally runs 
from the mouth night and day, often depriving the patient of sleep. 
Not infrequently a swelling of the lymphatic glands is also ob- 
served. Articulation and deglutition are interfered with from swell- 
ing of the tongue and ulceration of the gums, cheeks, palate, and 
tonsils. These symptoms, together with the fever, anorexia, mus- 
cular weakness, and headache which are constant accompaniments 
of ptyalism, render the condition of the patient very serious and 
tormenting. 

Chronic mercurial poisoning, or mercurial cachexia, is the effect 
produced by prolonged exposure to the fumes of mercury. The 
blood becomes thin and poor, with degeneration of the corpuscles. 
The person becomes emaciated, the heart is weak, and the whole 
muscular system impaired. Respiration is rapid and shallow, and 
the mental faculties are affected. Loss of memory, irritability of 
temper, melancholia, and, in rare cases, mania, may ensue. All the 
special senses are affected. Deafness, dimness of vision, impaired 
taste and sensation, as well as intestinal derangement, edema, artic- 
ular pains, and generally disordered secretions, manifest themselves. 

Mercurial cachexia frequently produces muscular tremors, usu- 
ally beginning in the upper extremities with gradual extension. 
Even paralysis of groups of muscles is often the result of chronic 
mercurial poisoning. 

Treatment of Poisoning. — In acute poisoning from corrosive sub- 



AL TERA TI VES. 249 

limate or other active salt of mercury it is necessary to evacuate 
the stomach as quickly as possible, and give white of eggs freely. 
The after-treatment is similar to that of other corrosive poisons — 
the use of demulcents and opiates. 

For salivation, potassium chlorate probably occupies the first 
place as a prophylactic and curative agent. It is employed as a 
gargle and mouth-wash in a 2 to 3 per cent, solution. An astrin- 
gent wash is frequently necessary. Such drugs as tannin, myrrh, 
krameria, etc. may be used for this purpose. Where there is ex- 
tensive ulceration of the mouth disinfectant and antiseptic solutions 
will be found desirable. 

In cases of chronic mercurial poisoning it is of primary import- 
ance to remove all traces of the drug from the system by means 
of iodides, the dosage being limited in quantity, but continued for 
some time. 

Elimination of the poison from the tissues may be accomplished 
in various ways — the potassium iodide administered alternately with 
magnesium sulphate, laxatives, sulphur baths, and sulphur given 
internally. A change of air, liberal and nutritious diet, and tonics 
are also necessary. 

Therapeutics. — Externally and Locally. — As a germicide, anti- 
septic, and antiparasitic the preparations of mercury are extremely 
valuable, the corrosive chloride of mercury being extensively em- 
ployed as an antiseptic in general surgery in strengths of from 
1 : 1000 to 1 : 10,000. 

In diseases of the skin due to animal or vegetable parasites there 
are no drugs so valuable as certain preparations of mercury, the 
ointment of ammoniated mercury being highly prized. 

Calomel in the form of an ointment, 5 to 20 grains (0.3-1.25 
Gm.) to I ounce (32.0 Gm.) is an efficient remedy in eczema. 

Indolent venereal ulcers are much improved by dusting them 
with calomel, while the early inflammatory conditions of these sores 
may be greatly benefited by the use of black wash. 

Many diseases of the eye, ear, nose, and throat yield to various 
preparations of mercury. The ointment of the yellow oxide of 
mercury is particularly adapted to phlyctenular ophthalmia, pannus, 
keratitis, chronic blepharitis marginalis, etc. 

Inunction with mercurial ointment or with oleate of mer- 
cury is excellent for the constitutional treatment of the first and 
second stages of syphilis. These two preparations are of great 
value in subacute synovitis, pelvic cellulitis, and syphilitic orchitis and 
epididymitis. 



250 A TEXT-BOOK OF MATERIA MEDICA. 

The ointment of the red iodide of mercury has a reputation 
as an efficient remedy in goiter and syphilitic enlargement of the 
spleen, as well as in pachymeningitis. 

The solution of nitrate of mercury is an active and reli- 
able caustic in the treatment of phagedenic ulcerations and venereal 
ulcerations of the os uteri. 

The use of mercurials is usually attended with excellent results 
in promoting resolution of fibrous induration resulting from chronic 
inflammation. 

Internally. — The principal use of mercury is undoubtedly as 
an antisyphilitic. Mercury is an antidote against constitutional 
syphilis, being particularly efficient in the secondary stage. Many 
methods of mercurializing a patient have been adopted, mention of 
which will be made under " Administration." It is perhaps un- 
necessary to caution the therapeutist to make an accurate and 
positive diagnosis of syphilis before instituting the mercurial treat- 
ment, as otherwise the consequences may be disastrous. 

Mercury has been used in all stages of the disease, though, 
possibly from ignorance of its proper use, its employment has met 
with less favorable results in the primary than in the secondary 
form, while a careful study of syphilology leads one to believe that 
in tertiary syphilis it is inferior to the iodides, if not, indeed, actually 
contraindicated. 

The medical uses of mercurial preparations in disorders of the 
alimentary tract are very numerous. 

Chronic dysentery will frequently yield to j-Jo" to To g ram 

(O.OOO6-O.OOOI Gm.) of CORROSIVE CHLORIDE OF MERCURY and 

diarrheas of children — particularly those characterized by pale, 
offensive stools — together with ileo-colitis of infants, are greatly 
benefited by small doses of calomel or gray powder, which will 
also allay obstinate vomiting. 

As a purgative in bilious attacks, hepatic congestion, and cirrhosis 
calomel is an extremely valuable drug. Its action as a purgative 
will be more fully described under " Cathartics." 

This drug is also a remarkably efficient diuretic. 

The internal use of mercury is of great value in all nonsuppu- 
rative inflammations, as cirrhotic conditions in the glandular struc- 
tures, or in scleroses in the nervous system, such as hepatic cirrhosis, 
chronic interstitial nephritis, locomotor ataxia, chronic endarteritis, 
chronic affections of the lungs and pleura, etc. 

Many acute febrile and inflammatory conditions, such as menin- 



AL TERA TIVES. 251 

gitis, pericarditis, and hepatitis, are sometimes benefited by the in- 
ternal administration of calomel, though in acute inflammations the 
chief value of the drug, whether specific or non-specific, is manifest 
in iritis and in acute bronchitis which shows a tendency to persist. 

Calomel given early in from 10- to 20-grain (0.6-1.0 Gm.) doses 
in cases of pneumonia is esteemed very highly by some authorities. 

Calomel and opium have been used and recommended by some 
physicians in the treatment of Asiatic cholera. 

The internal use of bichloride of mercury is unquestionably 
of much value in the treatment of diphtheria, and the subsulphate 
of mercury is an old and veiy effective emetic in membranous 
laryngitis. 

The author has often successfully treated marasmus of infants 
with bichloride of mercury administered three times a day in doses 
of from y^q to yJ-q- grain (0.0005-0.0006 Gm.). 

Contraindications. — Mercury is usually contraindicated in 
tuberculosis and in persons of strumous diathesis ; and, while it is 
of value when judiciously employed in chronic interstitial nephritis, 
it must nevertheless be given cautiously, and if the excretion of 
urine is diminished by its use, the drug should be immediately 
discontinued. 

Children, though not easily salivated, are very susceptible to 
other poisonous actions of calomel. 

Ordinarily, acute asthenic diarrhea and dysentery in adults would 
contraindicate the use of mercurials. 

Administration. — Mercuiy is introduced into the system by — 

1. Inunction. — The portion of the body upon which the prepa- 
ration is to be applied should first be thoroughly washed with soap 
and warm water, and the ointment well rubbed in with the palm of 
the hand. The best localities for application are the inner sides of 
the thighs, the sides of the chest, the axillae, abdomen, and back. 
An excellent way to mercurialize a child is to put the ointment on 
the abdomen beneath a flannel binder. An efficient means also of 
favoring absorption is to apply the ointment to the soles of the 
feet, when it will be rubbed in by walking. Mercurial ointment 
is ordinarily used for this purpose, 15 to 30 grains (1.0-2.0 Gm.) 
being required for each inunction. Oleate of mercury when applied 
externally should not be rubbed in, the simple application to the 
skin being sufficient. 

2. Fumigation. — The iodide, mercuric sulphide, and calomel are 
used in this manner. The latter preparation, being preferable, is the 



252 A TEXT-BOOK OF MA TERIA MEDICA. 

one ordinarily used. From 5 to 20 grains (0.3-1.2 Gm.) of calomel 
are put in a plate or a porcelain dish over a lighted spirit-lamp. 
These are placed under a cane-bottomed chair, in which the patient 
sits, nude, enveloped in a blanket reaching to the floor and fastened 
loosely about the neck. The calomel is volatilized by the heat, 
deposited in minute particles over the surface of the body, and read- 
ily absorbed. The fumigation should last fifteen to twenty minutes. 

3. Endermically : — Mercurials may be absorbed by dusting calo- 
mel and certain other preparations on ulcers, open wounds, etc. 

4. By the Rectum. — Mercury may be administered in the form 
of a suppository containing 5 to 10 grains (0.3-0.6 Gm.) of mer- 
curial ointment. 

5. Hypodermically. — From -^ to \ grain (0.005-O.OI Gm.) of 
the bichloride of mercury, dissolved in 5 to 10 minims (0.3-O.6 
Cc.) of distilled water, is injected deeply into the muscles of the 
gluteal region or in the subcutaneous areolar tissue of the back. 
The solution of peptonate of mercury has been used for this pur- 
pose, though the preparation which is the least objectionable is the 
solution of the formamidate of mercury, 16 minims (1.0 Cc), cor- 
responding to \ grain (0.1 Gm.) of mercuric chloride. 

A 1 per cent, solution of asparagin hydrargyrate has been 
highly recommended by Neumann for hypodermic use, the dose 
being about 15 minims (1.0 Cc), equivalent to \ grain (0.0 1 Gm.). 

Numerous other preparations have been recommended, but 
probably possess no advantage over those mentioned. 

6. Internally. — In the treatment of syphilis nearly every prepara- 
tion of mercury has been employed, authorities differing in their 
choice. Bumstead prefers the bichloride, the mercurous iodide, 
and the mercurial pill; Berkeley Hill, the red mercuric iodide; 
Fox, the cyanide ; Hutchinson, the gray powder, etc. It matters 
little which of these preparations is used. That which agrees best 
with the patient is advisable. Calomel, gray powder, blue pill, and 
corrosive sublimate are ordinarily used in disorders of the ali- 
mentary tract. As a rule, the first two are preferable. 

ARSENIC. 

Acidum Arsenosum — Acidi Arsenosi — Arsenous 

Acid. U.S.JP. 

(Arsenic Trioxide — White Arsenic.) 
Origin. — Arsenic has been found in minute proportions in many 
mineral waters. It is obtained in large quantities by roasting 



AL TERA TIVES. 253 

arsenical ores — cobalt, nickel, tin, and particularly arsenical iron 
pyrites — and purifying by resublimation. 

Description and Properties. — It is a heavy solid, occurring 
either as an opaque white powder or in irregular masses, of two 
varieties — the one, amorphous, transparent, and colorless, like 
glass ; the other, crystalline, opaque, or white, resembling porce- 
lain. Frequently the glassy variety is found enclosed in an opaque, 
white crust. Contact with moist air changes the glassy into the 
white, opaque variety. Both are odorless and tasteless. 

Both varieties dissolve very slowly in cold water, the glassy 
variety requiring about 30, the porcelain-like about 80, parts of 
water at 15 C. (59 F.). Both are slowly but completely soluble 
in 15 parts of boiling water. Arsenous acid is but slightly soluble 
in alcohol, but is soluble in about 5 parts of glycerin. Oil of tur- 
pentine dissolves the glassy variety only. Both varieties are freely 
soluble in hydrochloric acid and in solutions of alkali hydrates and 
carbonates. 

Dose. — ^ - ^q grain (0.001-0.003 Gm.). 

Official Preparations. 

Liquor Acidi Arsendsi — Liquoris Acidi Arsenosi— Solution of Arsenous 
Acid. — Strength, 1 per cent, of arsenous acid. 

Description and Properties. — A clear, colorless liquid, odorless, having an acidu- 
lous taste and an acid reaction. 

Dose. — 2-10 minims (0.12-0.6 Cc). 

Liquor Pot&ssii Arsenitis — Liquoris PotSssii Arsenitis — Solution of Potas- 
sium Arsenite (Fowler's Solution). — Strength, 1 per cent, of arsenous acid. 

Dose. — 2-10 minims (0.12-0.6 Cc). 

Arseni Iodidum— Arseni I odidi— Arsenic Iodide. 

U. S. JP. 

Origin. — Prepared by triturating in a mortar finely-powdered 
metallic Arsenic and Iodine until they are thoroughly mixed ; or by 
mixing solutions of Arsenous and Hydriodic Acids, and evapo- 
rating. 

Description and Properties. — Glossy, orange-red, crystalline 
masses, or shining, orange-red, crystalline scales, having an iodine- 
like odor and taste ; gradually losing iodine on exposure to air and 
light. Soluble in 7 parts of water and in about 30 parts of alcohol. 
Arsenic iodide should be kept in glass-stoppered vials, in a cool 
place, protected from light. 

Dose. — 3^-J grain (0.002-0.008 Gm.). 



254 A TEXT-BOOK OF MA TERIA MEDICA. 

Official Preparation. 

Liquor Arseni et Hydr&rgyri Iodidi — Liquoris Arseni et Hydrargyri Iodidi 
— Solution of Arsenic and Mercuric Iodide — (Donovan's Solution). — Strength: 
I per cent., each, arsenic iodide and mercuric iodide. 

Description and Properties. — A clear, pale-yellowish liquid, without odor, and having 
a disagreeable metallic taste. 

Dose. — i-io minims (0.06-0.6 Cc). 

Sodii Arsenas— Sodii Arsenatis— Sodjum Arsenate. 

TJ. S. JP. 

Origin. — Prepared by heating to redness Arsenous Acid, Sodium 
Nitrate, and Sodium Carbonate. Dissolve the fused mass in water, 
and crystallize. Dissolve crystals in water, and recrystallize. 

Description and Properties. — Colorless, transparent, mono- 
clinic prisms, odorless, and having a mild, alkaline taste (the salt is 
very poisonous). Efflorescent in dry air, and somewhat deliques- 
cent in moist air. Soluble in 4 parts of water, very soluble in 
boiling water, and slightly soluble in cold water. Soluble in 60 
parts of boiling alcohol. Sodium arsenate should be kept in well- 
stoppered bottles. 

Dose. — gV~ IT g ram (0.001-0.006 Gm.). 

Official Preparation. 

Liquor Sodii Arsenatis — Liquoris Sodii Arsenatis — Solution of Sodium 
Arsenate — (Pearson's Solution). — Strength: 1 per cent, of sodium arsenate. 
Dose. — 1-10 minims (0.06-0.6 Cc). 

Unofficial Preparations. 

Ciipri Arsenis — Cupri Arsenitis — Cupric Arsenite — (Scheele's Green, Min- 
eral Green, Paris Green, etc.). — Dose, y^ grain (0.0006 Gm.), daily, in divided 
doses. 

Liquor Arseni Bromidi — Liquoris Arseni Bromidi — Solution of Arsenic 
Bromide — (Clemens' Solution). — Strength: the equivalent of 1 percent, of arsenous 
acid. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Liquor Arseni et Aiiri Bromidi — Liquoris Arseni et Atiri Bromidi — Solu- 
tion of Arsenic and Gold Bromide. — Originated with, and recommended by. Dr. 
Barclay, and sold under the trade name " Arsenauro." Strength : 10 minims (0.6 Cc.) 
contain -J^ grain (0.002 Gm.) of each salt. 

Dose. — 5-15 minims (0.3-1.0 Cc). 

Antagonists and Incompatibles. — Arsenic is incompatible with 
the salts of iron, silver, magnesia, lime, copper, ammonium, and 
with vegetable astringents. 

Synergists. — The Restoratives and nux vomica are synergistic 
to arsenic. 



ALTERATIVES. 255 

Physiological Action. — Externally and Locally. — Applied to 
the skin, arsenic acts as a caustic, exciting violent inflammation. 
Its escharotic influence results in destruction of vitality in the 
affected parts, accompanied with sloughing. 

Internally. — Digestive System. — Except in very small doses 
arsenic acts as a severe gastro-intestinal irritant. Minute and 
medicinal doses stimulate the flow of gastric and intestinal juices, 
and augment peristalsis, improving the digestive and nutritive func- 
tions. When too long continued, the drug produces nausea, diar- 
rhea, and increased micturition, with a sensation of heat and dry- 
ness of the throat and stomach. Toxic doses are followed by 
violent gastro-enteritis. Indeed, in whatever manner introduced 
into the system, arsenic appears to have a marked selective action 
upon the gastro-intestinal tract. 

Circulatory System. — Cardiac action may be slightly stimulated 
by small doses, the experience of arsenic-eaters proving that the 
drug, so far from being necessarily deleterious, actually tends to 
invigorate the system. Large doses render the heart irritable and 
feeble and decrease the number of red corpuscles, rendering the 
blood less coagulable. Medicinal doses, while not increasing the 
number of red corpuscles, prevent their destruction in such dis- 
eases as pernicious anemia. Toxic doses induce, among other 
severe results, the characteristic arsenical symptom — fatty degen- 
eration of the cardiac muscle. " In large doses — that is, more than 
0.014 gramme (^.gr.) — it diminishes the excretion of urea and in- 
creases the excretion of phosphoric acid and chloride of sodium. 
In small doses, the elimination of uric acid being augmented, nutri- 
tion is increased because the chloride of sodium, the stimulant par 
excellence of nutrition and the preservative of the red corpuscles, is 
retained in the organism in larger quantities than normal, thus stim- 
ulating nutrition in spite of the loss of phosphoric acid. The con- 
trary is / the case when large doses are given, the unfavorable action 
being attributable first to the destructive effect of the drug on the 
red corpuscles, then to its action on the chloride of sodium, and 
finally to its action on the phosphoric acid." 1 

Nervous System. — The general effect of arsenic upon the brain 
and nervous system is that of a tonic — a property which is sup- 
posed to explain its antiperiodic nature, in which respect quinine 
alone is its superior. The cerebral functions are stimulated, even 
to the point of exhilaration. Experiments have shown that the 
sensory nervous apparatus is strongly and untowardly affected. 

1 Annual of Universal Medical Sciences, Issue of 1896, volume A, p. 32. 



256 A TEXT-BOqK OF MATERIA MEDICA. 

The action finally involves the motor system, complete paralysis 
supervening. Medicinal amounts act as a nervous excitant, stimu- 
lating the trophic apparatus (Hare). Large doses produce disorders 
of motility and sensibility, tremors, and other serious symptoms. 
It has been noted that the continued use of arsenic produces 
tingling and a sensation of numbness in the tips of the fingers. 

Under prolonged use arsenic tends to accumulate to a greater 
extent in nervous than in other tissues. Thus, according to 
Scolosuboff, if i part is found in fresh muscle, the proportion in 
the liver is 10.8 ; in the brain, 36.5 ; in the spinal cord, 37.3. 

Respiratory System. — Ordinary amounts effect no special change 
in respiration other than increased power and stimulation of the 
respiratory center. It has been held, with authority, that small 
doses stimulate the peripheral endings of the pulmonary vagi. In 
toxic doses arsenic acts as a powerful respiratory depressant. 

Absorption and Elimination. — Arsenic is readily absorbed by 
the blood. Its presence has also been detected in the viscera, bile, 
urine, sweat, the bronchial and intestinal mucous membranes, and 
even in the parenchymatous tissues. It is eliminated slowly from 
the system by the intestines, and rapidly by the urine ; possibly, 
also, by the bile and the skin. The saliva, milk, and even the 
tears, are said to share in the process of elimination. 

Medicinal doses prevent tissue-change, while large doses in- 
crease nitrogenous metamorphosis. The therapeutic action is cer- 
tainly to modify and improve nutrition. 

Temperature. — The temperature is unaffected by medicinal doses. 
Toxic doses are accompanied by a considerable rise in bodily heat, 
though the extremities are often cold. 

Eye. — Large doses of arsenic are followed by injection of the 
conjunctivae, eczema, inflammation, and edema of the lids. Zehn- 
der asserts that the prolonged administration of arsenic has caused 
retrobulbar neuritis, and Hutchinson believes vitreous opacities 
may result from such a course. 

Untoward Action. — Differing from the characteristic symptoms 
of poisoning occasionally produced by medicinal doses in very 
susceptible persons, there are induced, not infrequently, restless- 
ness, headache, alopecia areata, bronchitis, hoarseness, disturbances 
of digestion, thirst, coryza, and, in rare cases, epistaxis, anaphro- 
disia, icterus, lacrymation, photophobia, amblyopia, dermatitis, and 
various cutaneous eruptions, frequently followed by desquamation. 

An eruption resembling that of measles, produced by 3 drops 
(0.18 Cc.) of Fowler's solution, is reported by Macnal {Medical Times 



AL TERA TIVES. 257 

and Gazette, 1868). Falck reports a case in which arsenic produced 
a discolored sanguinolent eruption with erysipelatous swelling. 
Papules and erythematous pustules have also been observed. 

The variety of these eruptions is well, yet somewhat homeo- 
pathically, described by Imbert-Gourbeyre (quoted from Lewin) : 

" Eruptions petechial or ecchymotic, eruptions papular, vesicular, 
erysipelatous, pustular, — such are the principal forms of arsenical 
exanthemata." 

Poisoning. — Large doses of arsenic produce symptoms of acute 
poisoning, the drug almost immediately manifesting its character- 
istic effects upon the gastro-intestinal canal (to which it is a marked 
irritant), exciting active inflammation in its delicate membrane. 
Other symptoms are colicky pains in the stomach, looseness of 
the bowels, great pain in the esophagus, and edema of the face 
indicated by puffiness under the eyelids. The passages are at 
length similar to the " rice-water " discharges of cholera, although 
different from the latter in the presence of blood or serum. The 
purging becomes obstinate and exhausting. In certain cases other 
choleraic symptoms are especially manifested, as increasing cold- 
ness of the body and cramps. Among the more prominent symp- 
toms is violent vomiting, which, however, aids in eliminating the 
poison from the stomach. 

The effects of arsenic are somewhat variable, intestinal inflam- 
mation, as autopsies show, not always being present. The quan- 
tity requisite to produce poisoning is often dependent upon idio- 
syncrasy, minute doses having proved fatal, and large amounts 
followed by surprising recoveries. Frequently, in place of the 
usual symptoms, profound coma occurs from which the patient is, 
perhaps, never roused. Convulsions and localized paralysis have 
also been observed. It is well established, too, that absorption of 
arsenic from a wound or from injection into the blood causes 
stomachic and intestinal effects often as severe as those attend- 
ing its ingestion. 

Various cutaneous symptoms are recorded, and in some cases 
the effects of arsenical poisoning strongly resemble those of acute 
yellow atrophy of the liver. 

Chronic Poisoning. — This malady is frequently due to the fumes 
or powder of arsenic inhaled in certain processes connected with 
the arts and manufactures or from manufactured products, such as 
wall-paper, certain dyes, textile fabrics, etc. The symptoms are 

similar to those accompanying full doses of the drug, save that 

17 



258 A TEXT-BOOK OF MATERIA MEDIC A. 

they appear occasionally in a more aggravated form. Ordinarily, 
loss of appetite occurs, with nausea, abdominal pains, vomiting, 
mild diarrhea, and headache. The conjunctivae are injected, the 
eyes and nose watery. In severer cases peripheral neuritis may be 
induced, as well as herpes zoster and paralysis of the muscles of 
the limbs, particularly the extensors of the hands and feet. Ataxic 
gait and darting pains, with rapid loss of muscular power, are not 
infrequent. Death from arsenical poisoning, however, is commonly 
the result of gastro-enteritis or collapse. 

The post-mortem changes are usually characteristic of corrosive 
poisoning — ecchymoses, erosions, and softening of the mucous 
membrane. The lungs and bronchial membrane are frequently 
congested. There is also present marked fatty degeneration of the 
heart, kidneys, liver, and spleen. 

Treatment of Poisoning. — It is necessary that treatment be ex- 
peditious, and the agents and methods adopted carefully chosen. 
Vomiting often renders the use of the stomach-pump unnecessary, 
yet emetics are frequently serviceable, the cleansing of the stomach 
being of primary importance. Various antidotes have been suc- 
cessfully used, the best, chemically, being freshly prepared hydrated 
sesquioxide of iron, administered in water, 2 or 3 tablespoonfuls 
every fifteen or twenty minutes. Magnesia, chalk, and lime-water 
also serve as efficient antidotes. The temperature of the patient 
should be maintained, and demulcents (oil, milk, etc.) freely given. 
The after-treatment should include mucilaginous drinks, opiates if 
indicated, cathartics, and, in case of necessity, stimulants. 

Therapeutics. — Externally and Locally. — The chief use of 
arsenic locally is as an escharotic. For this purpose it is employed 
to destroy malignant growths, such as cancer, sarcoma of the skin, 
•and multiple sarcomatous degeneration of the lymphatic glands. In 
the latter affection the parenchymatous injection of 5 minims 
(0.3 Cc.) of Fowler's solution, diluted with twice the amount of 
distilled water, is used. 

Many of the pastes and " quack " cancer remedies owe most of 
their efficiency to arsenic. Manec's paste contains arsenous acid, 
15 grains (1.0 Gm.) ; black sulphide of mercury, 75 grains (5.0 
Gm.) ; burnt sponge, 35 grains (2.3 Gm.). 

The noted poudre caustique de Frere Cosine ou du Rousselot is a 
similar preparation, containing about the same quantity of arsenic. 

The solution of arsenous acid is an excellent local application 
to warts and corns. If these growths are very firm and horny, 
their removal may be facilitated by the previous application of 



AL TERA TIVES. 259 

solution of potassa. When used over large surfaces arsenic should 
be applied in good strength and heroically, so that active inflam- 
mation may be excited and the danger of absorption lessened. 

Internally. — Arsenic is a peculiarly efficient remedy in chronic 
scaly skin diseases. 

Like all other alteratives, it influences diseases of a chronic 
nature more favorably than acute disorders, invariably aggravating 
acute skin diseases. This drug, therefore, is one of the most valued 
remedies in psoriasis, lepra, and chronic squamous eczema. 

While arsenic cannot, perhaps, be classed as an alterative in the 
above-mentioned diseases, it undoubtedly yields uniformly better 
results than any other single drug. 

The solution of potassa is a valuable synergist to arsenic in 
these conditions, especially in eczematous cases. 

Pemphigus, prurigo, acne, and lichen ruber have also been fa- 
vorably influenced by the continued administration of Fowler's 
solution. 

In the successful management of these chronic skin diseases it 
is necessary that the preparation of arsenic employed be given in 
as large doses as can be tolerated by the patient, and the treatment 
continued unremittingly for a long period. 

Lymphoma, whether superficial or occupying the great cavities, 
is frequently benefited greatly by similar treatment. 

Asthma and bronchitis, whether acute or chronic, accompanying 
or succeeding scaly skin diseases, are singularly amenable to this 
medicine when the dose is carried to the full physiological limit. 
Another condition, dysmenorrhea, frequently noticed in women 
with a tendency to asthma or subject to chronic diseases of the 
skin, is often cured or greatly benefited by arsenic. 

The obstinate and often incurable disease known as pernicious 
anemia yields better to arsenic than to any other known remedy. 
The effect of the drug in this disease is not due to its increasing 
the number and quality of the red blood-corpuscles, but rather to 
its preventing or delaying their destruction in the portal circulation. 
It should be given continuously and in gradually increasing doses 
until symptoms of arsenical poisoning appear, when the increase 
should cease and the same dose be maintained for some time. By 
carefully watching the indications and by the timely use of lax- 
atives the dosage may be easily adjusted so that the full benefit 
may be derived from this invaluable drug. 

The statements in the preceding paragraph apply also to leukemia, 
whether splenic, myelogenic, or lymphatic, and to Hodgkiris disease. 



260 A TEXT-BOOK OF MATERIA MEDIC A. 

Arsenic ranks next to quinine in the treatment of malaria. 
Chronic cases in which quinine has lost its power are generally 
benefited in a marked manner by arsenic. It is a peculiar fact that 
relapses are fewer after the arsenic treatment than after the use of 
quinine. Moreover, arsenic can be administered in intermittent 
fever, frequently with as favorable results as quinine would give. 

Arsenic can be employed in cases of malaria at all times with- 
out regard to the presence or absence of fever or chills. 

The neuralgias, anemia, and headache of malarial origin are 
singularly amenable to this medicine. 

In the treatment of malaria with arsenic it must be remembered 
that the paroxysms of ague are not relieved at once, as is the case 
when quinine is the medicament used ; but they recur with less 
severity, and are of shorter duration, gradually declining until they 
disappear altogether. 

Fowler first reported the remarkable efficacy of arsenic in 
neuralgia of the intercostal and fifth pair of nerves. It is equally 
valuable in these cases whether the disease be due to malaria or 
to general debility. 

The author wishes to recommend urgently the use of arsenic in 
pulmonary phthisis. In certain forms of this disease he regards it 
equal, if not superior, to any other remedy. It is useful, however, 
only in those conditions which are characterized by excessive 
expectoration and a slow degenerative process. The good results 
of the arsenic treatment in these cases is shown in a conspicuous 
manner by a marked improvement in the general condition of the 
patient, there being a lessened pulmonary secretion, a reduction in 
temperature, improvement of the appetite, and consequent increase 
of the body-weight. Arsenic is contraindicated in phthisis when 
the cough is harsh and paroxysmal, with but scanty expectoration 
and a tendency to pulmonary hemorrhage. 

If this drug is specific in any one disease, it is so in chorea, 
very rarely failing to effect a cure when judiciously administered. 
It should be given in full doses, and increased as tolerance is 
established. 

This medicine seems to act equally well in gastralgia. It is also 
an efficient remedy in gastritis or the vomiting of gastritis, espe- 
cially in that occasioned by the excessive use of alcohol. Many 
irritative conditions of the stomach are relieved by minute doses of 
Fowler's solution. Excessive peristalsis, resulting in diarrhea, 
coming on immediately after taking food, is usually cured com- 
pletely by very small doses of Fowler's solution, alone or com- 



AL TERA TI VES. 2 6 1 

bined with an equal quantity of tincture of opium. Arsenic has 
also been recommended in gastric ulcer and cancer. 

It has proved of great service in hay fever, spasmodic asthma , 
and acute coryza. It is often very serviceable in catarrhal pneu- 
monia and in chronic bronchitis. Bromide of arsenic is highly 
recommended in diabetes mellitus. Rheumatoid arthritis is more 
favorably influenced by the use of arsenic than by any other medi- 
cine. It should be employed in the treatment of chronic rheuma- 
tism. Even in secondary syphilis a combination of mercury and 
arsenic has produced better results, in some cases, than mercury 
alone. Anstie has recommended arsenic in angina pectoris, alleging 
that it mitigates the severity of the attacks. Chronic diarrhea, 
when induced by intestinal fermentation or chronic malarial infec- 
tion, is sometimes greatly benefited by this drug. Constipation, 
also, if due to deficient intestinal secretion, may frequently be 
relieved by the administration of small doses of arsenic. 

Albuminuria dependent upon imperfect digestion of albuminous 
substances is almost invariably relieved by Fowler's solution taken 
with meals. 

Finally, arsenic is a valuable adjunct to iron in the treatment of 
simple anemia and chlorosis. 

Contraindications. — In acute skin diseases and pulmonary 
tuberculosis with a tendency to hemoptysis. 

Administration. — Arsenic should be given ordinarily after 
meals. There are certain conditions, however, requiring its admin- 
istration in small doses before meals. When it is desired to give 
arsenic in pill form, the arsenous acid should be used; and for 
solutions the liquor potassii arsenitis is usually preferred. 

In syphilitic disorders Donovan's solution is an excellent prepa- 
ration to use. 

Children are much less susceptible to the drug than adults, 
often being able to take adult doses with impunity. 

During a course of arsenic the patient should be instructed to 
watch carefully for the first untoward manifestations, such as puf- 
finess about the eyes, itching of the conjunctivae, nausea, diarrhea, 
or numbness of the fingers. Any one of these symptoms is an 
indication that the dose should not be increased ; and it may be 
necessary to lessen the dose, or even to discontinue the remedy 
altogether, for a while. 

There are two methods of getting a patient thoroughly under 
the influence of the drug : 

I. Begin with a full dose of Fowler's solution, and decrease I 



262 A TEXT-BOOK OF MATERIA MEDIC A. 

minim (0.06 Cc.) a day until a minim (0.06 Cc.) dose is reached ; 
then repeat the method. 

2. Begin with a small dose of Fowler's solution, and increase 1 
minim (0.06 Cc.) a day until untoward symptoms appear or the 
dose has reached 10 or 15 minims (0.6-1.0 Cc); then either re- 
peat the method or decrease the amount 1 minim (0.06 Cc.) a 
day. 

Enormous doses of arsenic can be given hypodermically, and it 
is then much less toxic than when given by the mouth. Equiva- 
lents of 20 (1.2 Cc), 50 (3.2 Cc), and indeed 100, minims (6.5 
Cc) of Fowler's solution have been given in this manner at a 
single dose without toxic symptoms. Arsenic often acts more 
efficiently when given in this manner than when given by the 
mouth. The liver has a strong elective affinity for arsenic, but it 
is absorbed through the alimentary canal with considerable diffi- 
culty. The toxic action expends itself almost wholly upon the 
stomach and upper portion of the intestine. The hypodermic use 
of arsenic distributes the drug through the system just as mercury 
is distributed by inunction, carrying it immediately to all parts of 
the system by the circulation. The arsenite of sodium is free from 
any objection for hypodermic use : it never causes the least sign of 
irritation. Fowler's solution is objectionable : it invariably causes 
much irritation, and frequently forms an abscess. 

Careful study of the effects of the drug in each case will make 
it possible to guard its administration so that tolerance can be 
established — a result much to be desired in order to secure the 
maximum benefit. 

Considering the enormous doses to which the arsenocophagi 
become habituated, failure in the medicinal administration of arsenic 
argues the want of ability to employ it scientifically. 

Cacodylates. — Organic compounds of arsenic are claimed to 
act much more slowly and less actively than the inorganic com- 
pounds. Such compounds are cacodylic acid and sodium caco- 
dylate, which have been introduced into modern therapy, although 
first suggested by Schmidt in 1869. It is extensively claimed that 
these bodies are non-irritating, but this is not the fact, although 
clinical experience would seem to show that much larger doses of 
arsenic can be taken as cacodylates than in any other form. The 
indications are the same as those in ordinary arsenic therapy. 
Dosage, -§— 1 grain. Renz in 1865 obtained poisonous effects from 
doses of from 10 to 18 grains of cacodylic acid. French observers 
maintain that the hypodermic use of the cacodylates gives different 



AL TERA TI VES. 263 

results than mouth medication. They recommend it to be given 
by the hypodermic. 

Iodum— Iodi— Iodine. U. S. i*. 

Origin. — It is found in the ashes of sea-weeds and is prepared 
from the mother-liquor obtained in the purification of Chili salt- 
petre. 

Description and Properties. — Heavy, bluish-black, dry and 
friable rhombic plates, having a metallic luster, a distinctive odor, 
and a sharp and acrid taste. It imparts a deep-brown, slowly 
evanescing stain to the skin, and gradually destroys vegetable 
colors. Iodine is soluble in about 5000 parts of water and in 10 
parts of alcohol, with a brown color ; also freely soluble in ether 
and in a solution of potassium iodide, with a brown color, and in 
chloroform or carbon disulphide, with a violet color. It should be 
kept in glass-stoppered bottles, in a cool place. 

Dose. — About J grain (0.016 Gm.), although seldom given in 
substance. 

Official Preparations. 

Liquor Iodi CompSsitus — Liquoris Iodi Comp6siti — Compound Solution 
of Iodine (Lugol's Solution). — Iodine, 5; Potassium Iodide, 10; Distilled Water, to 
make 100 parts. Strength, 5 per cent. Dose, 1-10 minims (0.06-0.6 Cc). 

Tinctiira Iodi — Tincturae Iodi — Tincture of Iodine. — Iodine, 70; Alcohol, to 
1000. Strength, 7 per cent. Dose, 1-5 minims (0.06-0.3 Cc.). 

Unguentum Iodi — Unguenti Iodi — Iodine Ointment. — Iodine, 4; Potassium 
Iodide, 1 ; Water, 2 ; Benzoinated Lard, 93. Strength, 4 per cent. For external use. 

Syrupus Acidi Hydriodidi— Syrupi Acidi Hydriodidi 
—Syrup of Hydriodic Acid. U. 8. P. 

A syrupy liquid containing about I per cent, by weight of 
hydriodic acid. 

Description and Properties. — A transparent, colorless, or only 
pale straw-colored liquid, odorless, and having a sweet and acidu- 
lous taste 



Dose. — J-2 fluidrachms (2.0-8.0 Cc). 



Ammonii Iodidum— Ammonii Iodidi— Ammonium 
Iodide. U. S. -P. 

Origin. — It is prepared by dissolving Potassium Iodide and 
Ammonium Sulphate in boiling Water, adding Alcohol, filtering, 
washing the filtrate, and evaporating it to dryness. 



264 A TEXT-BOOK OF MA TERIA MEDICA. 

Description and Properties. — Minute, colorless, cubical crys- 
tals, or a white, granular powder, without odor when colorless, but 
emitting a slight odor when colored, and having a sharp, saline 
taste. The salt is hygroscopic, and soon becomes yellow, or 
yellowish-brown, on exposure to the air and light, owing to the 
loss of ammonia and the elimination of iodine. Soluble in 1 part 
of water and in 9 parts of alcohol. Ammonium iodide should be 
kept in small, well-stoppered vials, protected from light. 

Dose. — 3-20 grains (o. 1 8-1.2 Gm.). 

Potassii Iodidum— Potassii Iodidi— Potassium 
Iodide. 77. 8. JP. 

Origin. — Iodine is dissolved in a solution of Potassa in hot dis- 
tilled Water. The solution is evaporated, and the residue heated 
with charcoal. Dissolve in boiling Water, filter, wash the filtrate, 
and crystallize. 

Description and Properties. — Colorless, transparent or trans- 
lucent, cubical crystals, or a white, granular powder, having a pecu- 
liar, faint, iodine-like odor, and a pungent, saline, and afterward 
bitter taste. Permanent in dry air and but slightly deliquescent in 
moist air. Soluble in 0.75 part of water and in 18 parts of alcohol ; 
also soluble in 2.5 parts of glycerin. Potassium iodide should be 
kept in well-stoppered bottles. 

Dose. — 2-30 grains (0.12-2.0 Gm.). 

Official Preparation. 

Unguentum Pot&ssii Iodidi — UnguSnti Pot&ssii Iodidi — Ointment of Po- 
tassium Iodide. — Potassium Iodide, 12; Sodium Hyposulphite, i; Water, 10; Ben- 
zoinated Lard, 77. For external use. 

Sodii Iodidum— Sodii Iodidi— Sodium Iodide. IT. S. P. 

Origin. — Prepared from a solution of Soda in a manner similar 
to the preparation of potassium iodide. 

Description and Properties. — Colorless, cubical crystals, or a 
white, crystalline powder, odorless, and having a saline and slightly 
bitter taste. In moist air it deliquesces and becomes partially de- 
composed into sodium carbonate and free iodine, assuming thereby 
a reddish color. Soluble in 0.6 part of .water and in about 3 parts 
of alcohol. It should be kept in well-stoppered bottles. 

Dose. — 2-30 grains (0.12-2.0 Gm.). 



ALTERATIVES. 265 

Strontii Iodidum— Strontii Iodidi — Strontium Iodide. 

U. S. JP. 

Origin. — Prepared by neutralizing freshly prepared solution of 
Hydriodic Acid with Strontium Carbonate, concentrating the nitrate, 
and crystallizing. 

Description and Properties. — Colorless, transparent, hex- 
agonal plates, odorless, and having a bitterish, saline taste ; deli- 
quescent and colored yellow by exposure to air and light. 
Soluble in 0.6 part of water, also soluble in alcohol, and slightly 
in ether. It should be kept in dark, amber-colored, glass-stop- 
pered vials. 

Dose. — 2-30 grains (0.12-2.0 Gm.). 

ZInci I5didum— Zinci Iodidi— Zinc Iodide. U.S.I*. 

Origin. — Obtained by dissolving Zinc Oxide or Carbonate in 
Hydriodic Acid, or digesting Granulated Zinc in 10 parts of Iodine 
and 20 parts of Water, and evaporating to dryness. 

Description and Properties. — A white, granular powder, odor- 
less, and having a sharp, saline, and metallic taste. Very deliques- 
cent, and liable to absorb oxygen from the air and to become 
brown from liberated iodine. Readily soluble in water, alcohol, or 
ether. Zinc iodide should be kept in small, glass-stoppered bot- 
tles. 

Dose. — 1-3 grains (0.06-0.18 Gm.). 

Sulphuris Iodidum— Sulphuris Iodidi— Sulphur 
Iodide. U. S. JP. 

Origin. — Prepared by heating Washed Sulphur and Iodine in a 
flask until the ingredients combine. 

Description and Properties. — Brittle masses, of a crystalline 
fracture and a grayish-black, metallic luster, having the odor of 
iodine and a somewhat acrid taste. Almost insoluble in water; 
soluble in about 60 parts of glycerin ; very soluble in carbon di- 
sulphide. Alcohol and ether dissolve out the iodine, leaving the 
sulphur. Sulphur iodide should be kept in glass-stoppered bottles, 
in a cool place. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Unofficial Preparation. 
UnguSntum Sulphuris Iodidi— Unguenti Sulphuris Iodidi— Ointment of 
Sulphur Iodide.— Sulphur Iodide, 30 grains (2.0 Gm.) ; Lard, I ounce (30.0 Gm.). 
For external use. 



266 A TEXT- BOOK OF MATERIA MEDIC A. 

Plumbi Iodidum— Plumbi Iodidi — Lead Iodide. 

U. S. P. 

Origin. — Mix solutions of Lead Nitrate and Potassium Iodide, 
filter, wash the precipitate with Distilled Water, and dry it at a 
gentle heat. 

Description and Properties. — A heavy, bright-yellow powder, 
without odor or taste. Permarent in the air. Soluble in 2000 
parts of water ; very slightly soluble in alcohol, but soluble, with- 
out color, in solutions of the fixed alkalies, in concentrated solu- 
tions of the acetates of the alkalies, of potassium iodide, and of 
sodium hyposulphites, and in a hot solution of ammonium chloride. 
Lead iodide should be kept in well-stoppered bottles, protected 
from light. 

Dose. — \ grain (0.013 Gm.), although, as a rule, this drug is 
employed externally. 

Arg-enti Iodidum— Argenti Iodidi— Silver Iodide. 

U. S. jP. 

Origin. — Aqueous solutions of Silver Nitrate and of Potassium 
Iodide are poured together ; the precipitate is then collected upon 
a filter and washed with Distilled Water and dried upon bibulous 
paper. 

Description and Properties. — A heavy, amorphous, light-yel- 
lowish powder, unaffected by light if pure, but generally becom- 
ing somewhat greenish-yellow, and having neither odor nor taste. 
Insoluble in water and alcohol. 

Dose. — |— 2 grains (0.008-0.13 Gm.). 

Allied Compounds. 

Iodi Bromidum — Iodi Bromidi — Bromide of Iodine. — Origin. — Obtained by 
heating together Iodine and Bromine. 

Description and Properties. — A dark, reddish-brown liquid, resembling bromine in 
appearance and sensible properties, but yielding a perfectly transparent, brown-red solu- 
tion with less than 6 parts of water. For external use. 

Iodi Chloridum — Iodi Chloridi — Iodine Chloride (Iodine Trichloride). — 
Origin. — Prepared by passing dry Chlorine Gas over dry Iodine. 

Description and Properties. — Orange-yellow needles, gradually changing to large, 
transparent, rhombic plates. It has a penetrating, pungent odor, resembling bromine. 
Soluble in 5 parts of water, and also in alcohol an& ether. 

Dose. — \ grain (o.oi Gm.), and externally in jq-} per cent, aqueous solution. 



Other compounds of iodine, used internally, are numerous. 
Some of those more recently brought to the practitioner's atten- 



ALTERATIVES. 267 

tion are : iodic acid and its compounds ; iodine tribromide ; iodine 
trichloride ; iodopin, a compound of sesame oil and iodine, recom- 
mended as alterative ; iodoalbumin ; iodophenine, a combination 
of iodine and phenacetine, used in rheumatism in 8-grain doses ; 
iodopyrine, an analogous compound ; iodotheine, iodine and theine, 
a heart stimulant ; iodotheobromin, analogous to the last, and 
iodothyrin (see under thyroid extract). 

Antagonists and Incompatibles. — Iodine and the iodides are 
antagonized by most of the Restoratives. Iodine is incompatible 
with the alkaloids and most of the mineral salts and acids, and 
with ammonia. The iodides are incompatible with mineral acids 
and acid salts, bismuth subnitrate, alkaloids, silver nitrate, soluble 
lead salts, spirit of nitrous ether, potassium chlorate, liquorice, and 
preparations containing starch. The tincture of iodine is incom- 
patible with water and aqueous preparations. 

Synergists. — The specifics, alkalies, and remedies increasing 
waste. 

Physiological Action. — Externally and Locally. — Iodine is a 
powerful disinfectant and rubefacient, as well as vesicant, caustic, 
parasiticide, and antiseptic. When applied to the skin or mucous 
membrane it produces a yellow, brown, or black stain, and is irri- 
tant or caustic according to the strength and frequency of the 
application. The discoloration, however, can be easily removed 
by sodium hyposulphite or ammonia. 

It combines with the albumin of the tissues and prevents putre- 
factive changes. When tincture of iodine is frequently applied or 
large amounts are used, desquamation of the skin is produced, and 
sometimes rapid vesication, or perhaps sloughing. The blood- 
vessels of the organs subjacent to the area to which it is applied 
are reflexly dilated, rendering this drug an efficient counter-irritant. 

The vapor of iodine when inhaled produces considerable irrita- 
tion of the respiratory passages, exciting cough, sneezing, increased 
secretion of mucus, dyspnea, and more or less pain in the chest, 
although when inhaled in moderate amounts its antiseptic proper- 
ties exert a beneficial influence upon the bronchial tissues, prevent- 
ing decomposition of the secretions. 

The iodides have no local action. 

Internally. — Digestive System. — Taken internally in small doses, 
iodine acts as a gastric tonic, minute doses acting as a sedative, 
allaying nausea. In other cases a single moderate dose may occa- 
sion gastric uneasiness, larger amounts intensifying the discomfort 



268 A TEXT-BOOK OF MATERIA MEDICA. 

and causing violent vomiting, increased salivary flow, abdominal 
pains, and purging. 

The iodides in moderate doses produce a sense of warmth in 
the stomach, larger amounts acting like iodine, though less irri- 
tating to the gastro-intestinal tract than the, latter drug. 

Owing to their rapid diffusibility, the iodides can be tasted in a 
few minutes after their ingestion, considerably increasing the flow 
of saliva. 

Circulatory System. — The effects of iodine and its salts have 
been variously reported, it being claimed that their tendency is to 
contract the vessels and cause increased cardiac action. Intro- 
duced into the veins, a slight increase, followed by decrease of 
pressure, has been observed. The rapidity of elimination from the 
blood is doubtless an impediment to any marked action on the 
circulation. Trasbot claims that potassium iodide dilates the 
blood-vessels, thereby increasing glandular secretion. 

The iodides are all supposed to be converted into the sodium 
iodide in the blood, without modifying the composition of that 
fluid. 

They probably form a loose combination with proteids. 

Nervous System. — No special action is recorded, although the 
potassium iodide is known to occasion unpleasant symptoms, in- 
cluding distress of mind and depression of spirits, accompanied 
now and then by lassitude and muscular debility — symptoms due 
rather to the influence of potassium upon the spinal cord. 

Respiratory System. — Little or no effect from medicinal doses 
has been noted. 

Absorption and Elimination. — Iodine and the iodides are rapidly 
absorbed by the mucous membranes generally, being found in the 
blood, mainly in combination with sodium. 

Elimination takes place by various channels — the urine, saliva, 
milk, intestinal and nasal mucous membranes. Salivary elimina- 
tion appears to be even more active than the urinary process, 
although the drug escapes largely through the kidneys, increasing 
the amount of water, urea, uric acid, and phosphoric and sul- 
phuric acids excreted. At the points of elimination the iodine 
escapes in its nascent state, occasioning more or less irrita- 
tion. 

It should be borne in mind that iodine, as iodothyrine, is a nor- 
mal constituent of the thyroid gland. 

Temperature. — -No effects have been noted, the temperature 



AL TERA TI VES. 269 

appearing to remain stationary even in the presence of decidedly 
untoward symptoms. 

Eye. — Beyond a local congestion of the minute vessels of the 
sclerotic coat under certain conditions little effect has been ob- 
served. The symptoms of ocular iodism at times present are 
described under " Poisoning." 

Uterus. — Small doses may increase or hasten the menstrual 
flow and act as aphrodisiacs ; larger doses have a marked anaphro- 
disiac effect ; while prolonged administration may result in atrophy 
of the ovaries. It has been maintained with authority that the 
catamenia are liable to increase, and that during pregnancy the 
drug may cause abortion. 

Untoward Action. — The untoward manifestations, in susceptible 
patients, are identical with those of iodism. 

Poisoning. — Taken in excessive doses, iodine acts as a poison, 
and has even produced death, though rarely. The symptoms of 
acute poisoning are those of severe gastro-enteritis, characterized 
by distressing stomachic and abdominal pains, accompanied by 
painful irritation of the esophagus, followed by violent purging and 
vomiting. 

An early symptom is a strong metallic taste in the mouth, to- 
gether with increased salivation. Suppression of urine, hiccough, 
and dysenteric pain have been reported in a fatal case resulting 
from external application (Biddle, p. 460). Very immoderate doses 
are attended with rapid and feeble pulse, deathly pallor, severe 
renal irritation affecting urinary secretion, and final loss of vital 
power followed by respiratory failure. 

The condition induced by prolonged or excessive use of iodine 
or its salts is known as Iodism. Together with a metallic taste 
there are present tenderness of the teeth and gums, nausea and 
coryza or symptoms of gastric irritation, acneiform eruptions — 
even a vesicular and purpuric variety not infrequently occurs — 
while under continued dosage the coryza becomes more pro- 
nounced, accompanied by edema of the eyelids, lacrymation, and 
ocular pains. Moreover, muscular twitchings, edema of the glottis, 
neuralgic pains, and atrophy of mammae, testicles, and other tis- 
sues occasionally supervene. Anemia and even cachexia are often 
manifest. 

Treatment of Poisoning, — The use of large amounts of starch, 
in the form of , arrowroot or starch-water, has been successfully 
adopted as an antidote. Hypodermic injections of ammonia, 



270 A TEXT-BOOK OF MATERIA MEDICA. 

strychnine, digitalis, alcohol, and atropine have been employed 
with excellent results, as tending to restore the circulation and 
assist respiratory movements. More recently bicarbonate of so- 
dium has proved an efficient antidote. 

The use of the stomach-pump and the application of heat to 
the body and extremities are naturally of the first importance. 

Therapeutics. — Externally and Locally. — The tincture, com- 
pound solution, and ointment are extensively employed as coun- 
ter-irritants and as aids to the absorption of fluid. The tincture is 
an efficient application to joints in chronic rheumatism , gout, and 
synovitis, and in pleurisy, both for the purpose of aborting an 
attack and to aid the absorption of fluid when effusion has taken 
place. In neuritis, onychia, periostitis, venereal bubo, glandular 
swellings, etc. the tincture, applied externally, will often be of 
service. 

This same preparation is of marked benefit when hypodermi- 
cally injected in goiter, particularly of the soft or cystic variety, 
hydrocele, empyema, extensive serous arthritic effusion unaccompanied 
by inflammation, spinal meningocele, and anal fistula. 

The tincture is also a very efficient application in chronic metritis 
and chronic endometritis. 

In many diseases of the skin iodine serves a useful purpose as 
a discutient and parasiticide, lentigo, lupus, chloasma, tinea tonsurans, 
etc. especially indicating its use. 

Many chronic splenic and hepatic disorders are favorably influ- 
enced by an external application of the iodine ointment. 

The tincture of iodine has been recommended as an efficient 
application in recession of the gums attendant upon pyorrhoea 
alveolaris. 

The vapor of iodine is frequently employed in subacute ca- 
tarrhal deafness and in acute coryza. 

A mixture of tincture of iodine \ fluidrachm (2.0 Cc), carbolic 
acid 10 minims (0.6 Cc), glycerin and water, each, \\ ounces 
(45.0 Cc), has been highly recommended by Samuel Johnston in 
the treatment of chronic pharyngitis. 

As an inhalant in chronic laryngitis and phthisis iodine in some 
form is highly esteemed by many physicians. 

Internally. — One of the principal and most important uses of 
iodine and the iodides is in the treatment of secondary and tertiary 
syphilis. All the manifestations of this disease, such as syphilitic 
periostitis, meningitis, endarteritis, gummata, paralysis, etc., are re- 



AL TERA TI VES. 2 7 1 

lieved by large doses of the iodides to saturation of the system. 
The more chronic the disease, the larger the dose required ; and 
the more acute the attack, the smaller the dose. 

Iodine is peculiarly useful in combining with and eliminating 
mercury from the system of patients suffering from mercurial 
cachexia, paralysis, etc. Other metals, lead, etc., are readily elim- 
inated by a course of potassium iodide. 

Potassium iodide is of marked utility in arresting the various 
manifestations of scrofula, such as ijiflammation and ulceration of 
cartilaginous structures and mucous catarrhs, and hastening the reso- 
lution of adenitis and enlargement of lymphatics. 

With regard to the use of iodine in the treatment of aneurysm 
of the aorta Walshe says : " Not only has relief of neuralgic pains 
and of the general distress followed its administration, but the local 
pressure-symptoms have been mitigated, and firm thrombosis has 
taken place within the sac, while the area of pulsation and of per- 
cussion-dulness has exhibited sensible reduction." Other authori- 
ties have reported favorably of its use in this condition. 

As a cardiac tonic iodine is of undoubted value, being especially 
serviceable in fatty degeneration of the heart, and in usually miti- 
gating the symptoms of chronic valvular diseases of the heart, 
especially those of the aortic orifice. It is a particularly useful 
remedy in chronic asthma and bronchitis, and to hasten the removal 
of inflammatory products of pneumonia, pleurisy, and pericarditis. 

The spasmodic asthma of adults and the bronchitis of children, 
both of which alternate with eczematous attacks, are greats- 
relieved by the potassium iodide. 

Even hereditary asthma occurs at less frequent intervals and in 
a milder form when the patient is kept constantly under the influ- 
ence of moderate doses of this drug. 

In the early stages of cirrhosis, whether of the liver or kidneys, 
as well as in sclerosis of the cord, it is an efficient remedy. The 
dropsy of splenic or hepatic induration is relieved by iodine, while 
in the various forms of muscular rheumatism it is one of the most 
potent medicaments. It has been advocated as a successful remedy 
in sciatica and chronic gout. 

It unquestionably retards the changes in chronic interstitial 
nephritis, though the tincture of iodine in these cases is considered 
superior to the potassium iodide. 

Ammonium iodide is highly recommended as an efficient rem- 
edy in acute catarrhal pneumonia and capillary bronchitis. It is 



272 A TEXT-BOOK OF MATERIA MEDICA. 

especially useful in catarrhal jaundice, and has, moreover, been 
suggested as a good remedy in hay fever and in malarial fevers. 

The syrup of hydriodic acid has been commended by Craig 
as a valuable agent in acute rheumatism. Small doses of the tinct- 
ure of iodine have been found efficient in the vomiting of pregnancy. 

Contraindications. — -The i irug should be discontinued at once 
when symptoms of iodism appear. It is contraindicated also in 
pulmonary tuberculosis when there is rapid change taking place 
in the lung. The iodides should not be given immediately before 
or after the administration of quinine. 

Administration. — The sodium iodide is less active and toxic 
than the potassium salt. The strontium iodide may be used for 
the same purposes as the other iodides, and possesses the advantage 
of disturbing the stomach less, besides being less likely to produce 
iodism. 

The iodides should be given in a large quantity of liquid. Their 
unpleasant taste may be concealed to a considerable extent by 
dissolving them in carbonic-acid water or Vichy water. Milk, com- 
pound syrup of sarsaparilla, and currant and raspberry syrups have 
all been used for this purpose. 

It is said that tincture of belladonna or sodium bicarbonate 
prevents the coryza caused by the iodides. 

The syrup of hydriodic acid is quite pleasant to the taste, and 
has but little tendency to produce iodism or untoward effects. 
This preparation should always be administered upon an empty 
stomach. 



Colchicum— Colchici— Colchicum. U. S. JP. 

(Meadow Saffron.) 

Origin. — A plant indigenous in Europe, in the southern and 
central portions of which it is frequently found in pastures and 
meadows, flowering in September or October, and ripening its 
seeds in June following. The root and seeds are official. 

Description and Properties. — The root is about I inch (25 
Mm.) long, ovoid, flattish, with a groove on one side ; externally 
brownish and wrinkled, internally white and solid ; often in trans- 
verse slices reniform in shape, and breaking with a short, mealy 
fracture ; inodorous ; taste sweetish, bitter, and somewhat acrid. 

Dose. — 2-8 grains (0.12-0.5 Gm.) in powder. 



ALTERATIVES. 273 

Official Preparations of the Root. 

Extr^ctum C61chici RSdicis — Extr5cti C61chici Radicis — Extract of Col- 
chicum Root. — Dose, \-2 grains (0.03-0.12 Gm.). 

Extr^ctum C81chici RSdicis Fluidum — ExtrScti CSlchici R&dicis Fluidi — 
Fluid Extract of Colchicum Root. — Dose, 2-8 minims (0.12-0.5 Cc). 

Vinum Colchici RSdicis — Vini C61chici RSdicis — Wine of Colchicum 
Root. — Dose, 5-20 minims (0.3-1.2 Cc). 

Colchicum seeds are subglobular, about ^ mcn ( 2 Mm.) thick, 
very slightly pointed at the hilum ; reddish-brown, finely pitted, 
internally whitish ; very hard and tough ; inodorous ; taste bitter 
and somewhat acrid. 

Both the corm (root) and seeds contain two alkaloid like bodies, 
colchicine and colchice'in. These are closely related and have iden- 
tical actions. 

Dose of the Powdered Seeds. — 1-5 grains (0.06-0.3 Gm.). 

Dose of Colchicine. — jio"^^ grain (0.00 12-0.00 1 Gm.). 

Official Preparations of the Seed. 

ExtrSctum C61chici SSminis Fluidum — Extr&cti CSlchici SSminis Fluidi — 
Fluid Extract of Colchicum Seed. — Dose, 1-5 minims (0.06-0.3 Cc). 

Tinctura C61chici SSminis — Tincturae C61chici SSminis — Tincture of Col- 
chicum Seed. — Dose, 10-30 minims (0.6-2.0 Cc). 

Vinum C61chici SSminis — Vini C61chici SSminis — Wine of Colchicum 
Seed. — Dose, 10-30 minims (0.6-2.0 Cc). 

Antagonists and Incompatibles. — Alcohol and opium antago- 
nize the cardiac depression produced by colchicum. Tannic acid 
and vegetable infusions containing it are incompatible, forming an 
insoluble tannate with the alkaloid. 

Synergists. — Diuretics, purgatives, emetics, and alkalies pro- 
mote the therapeutic activity of colchicum. 

Physiological Action. — Externally and Locally. — Colchicum is 
a decided local irritant, and when applied to the skin acts as a 
rubefacient. The dust when inhaled excites sneezing. 

Internally. — Digestive System. — In small medicinal doses colchi- 
cum slightly stimulates the salivary, gastric, biliary, and intestinal 
secretions. If these doses are repeated for several days, a sensa- 
tion of heat is experienced in the epigastrium, accompanied by loss 
of appetite and frequently by nausea. Full medicinal doses may 
produce purging and colic. Larger doses occasion profuse watery 
and choleriform or bloody evacuations from the bowels, severe 
abdominal pain and tenderness, excessive vomiting — in fact, all the 
symptoms produced by a violent gastro-intestinal irritant. 

18 



274 A TEXT-BOOK OF MATERIA MEDICA. 

Circulatory System. — Full medicinal or larger doses produce 
great depression of the circulation, with a small, rapid, and thready 
pulse. The marked cardiac depression and collapse which occur 
when poisonous doses of colchicum have been taken are more the 
result of the severe gastro-enteritis than of any direct action upon 
the heart. 

Nervous System, — The nervous system is unaffected by medici- 
nal doses. Even when poisonous doses have been taken the 
intellect usually remains unimpaired, though Toulmouche has seen 
the drug induce marked cerebral excitement. Discordant state- 
ments have been made regarding the action of colchicum upon the 
nervous system. The drug evidently affects different persons dif- 
ferently. Thus numbness or prickling, muscular pains or spasms, 
and occasionally convulsions, have been noticed ; yet the recent 
investigations of Laborde and Houde upon the action of colchicine 
show that it has no influence upon the centers of intelligence and 
volition, and does not induce paralysis of central origin, either 
motor or sensory, though the sensory nerves are considerably 
depressed. 

Respiratory System. — Large or poisonous doses of colchicum 
render the respiratory movements slow and shallow. This action 
is not due to any direct effect upon the respiratory center — al- 
though Rossbach and Wehmer maintain the contrary — but reflexly 
to the depression occasioned by the violent action of the drug upon 
the gastro-intestinal tract. 

Absorption and Elimination. — Colchicum is quite rapidly ab- 
sorbed, and is eliminated chiefly by the bowels and kidneys, the 
skin sharing to some extent in the excretory process. Some ob- 
servers allege that colchicum does not increase the amount of 
urine or the excretion of urea and uric acid, while others claim 
that these substances are increased. The author's experiments 
are sufficient to satisfy him that the excretion of all these sub- 
stances is considerably heightened under medicinal doses of col- 
chicum. 

Temperature. — Under moderate medicinal doses the temperature 
is unaffected, though doses large enough to produce emeto-cathar- 
sis are followed by a reduction of temperature. 

Untoward Action. — Many symptoms described under " Poison- 
ing " have been produced by very small doses. It is a matter of 
speculation whether these untoward manifestations were due to a 
decided idiosyncrasy on the part of the patient, or to the fact that 



ALTERATIVES. 275 

the preparation employed might have contained an unusually large 
percentage of the alkaloid. 

Poisoning. — The symptoms of poisoning by colchicum are vio- 
lent vomiting and purging, griping and intense pain in the abdomen, 
and at times excessive salivation or possibly convulsions. While 
death is for a time delayed under a poisonous dose, a fatal termina- 
tion is almost inevitable. Meanwhile the patient suffers excruci- 
atingly, being little relieved by treatment. 

Treatment of Poisoning. — All that can be done is to combat 
symptoms, giving opium for pain, oil and demulcent drinks for the 
irritation, and stimulants to counteract respiratory and cardiac 
depression. Washing out the stomach or the use of emetics may 
be required. Tannic acid serves as a partial antidote, precipitating 
the colchicine. 

Therapeutics. — Externally and Locally. — Colchicum has no 
local therapeutic action. 

Internally. — Colchicum is the typical vegetable specific. Its 
effects are in many ways analogous to those of mercury and iodine, 
even resulting in fatty degeneration of the liver, loss of hair, nails, 
teeth, etc. 

The drug is as valuable and certain a specific for gout as is mer- 
cury for syphilis. Gout in all its varied manifestations is relieved 
by this invaluable remedy. Diarrhea, dysentery, dyspepsia, bron- 
chitis, asthma, neuralgia, and eczema dependent upon a gouty condi- 
tion are singularly benefited by colchicum. 

This medicine, while at times efficacious in chronic rheumatism, 
and occasionally of some benefit in rheumatoid arthritis, is of no 
value in acute articular rheumatism. 

Its value is more apparent in acute than in chronic gout, and in 
the first attacks than in succeeding ones. Chronic gout, as well as 
chronic rheumatism, yields better to a combination of colchicum 
and potassium iodide than to colchicum alone. 

Some physicians recommend hypodermic injections of colchi- 
cine into the sheath of the nerve in sciatica. The author's quite 
limited use of this method has resulted in so much local irritation 
that he is prompted to caution the reader against the hypodermic 
employment of this drug. 

In combination with certain other agents colchicum serves an 
excellent purpose as a cholagogue, full doses being frequently very 
effective in relieving ascites due to obstructive diseases of the liver. 

Colchicum is sometimes employed as a drastic purgative in 



276 A TEXT-BOOK OF MATERIA MEDICA. 

cerebral and portal congestion, although when given in doses suf- 
ficient for this purpose it occasions considerable nausea and abdom- 
inal distress. 

Colchicum has also been recommended in the treatment of 
gonorrhea and chordee. 

In doses of -^ grain (0.00 1 Gm.) colchicine has been suggested 
by Darier in certain inflammatory diseases of the eye. Hypochon- 
driasis resulting from renal insufficiency is frequently benefited by 
colchicum. 

Contraindications. — The drug would be contraindicated in 
acute inflammatory conditions of the gastro-intestinal tract. It 
should be cautiously administered to old people. 

Administration. — The liquid preparations are to be preferred, 
and, in order to secure the full curative effects of the drug, it is 
unnecessary to give it in doses sufficiently large to excite vomiting 
or purging. The initial dose, therefore, should be small, that it 
may occasion no gastric disturbance. 

The beneficial effects of colchicum may be enhanced by first 
emptying the intestinal canal by means of a saline cathartic. 

The preparations of colchicum vary greatly in strength. The 
crude drug contains different percentages of the alkaloids, accord- 
ing to the season of the year in which the plant is gathered, the 
colchicum root collected in July and August containing the largest 
percentage of colchicine. Owing to this variation in strength the 
assayed tincture or the alkaloid is recommended as the best prepa- 
ration to use, though, because of its activity and poisonous prop- 
erties, the alkaloid should be given in very small doses at first — 
not to exceed j^-q of a grain (0.0005 Gm.) two or three times 
a day. 

Gualaci Lignum— Gualaci LIgni— Guaiacum Wood. 

U. S. I>. 

(Lignum Vitje.) 

Origin. — The heart-wood of Guaiacum officinale L. and of Guai- 
acum sanctum L., trees indigenous in the West Indies and on the 
northern coast of South America. The former is about 40 feet 
(12 M.) high, having evergreen pinnate leaves. 

Description and Properties. — The wood is heavier than water, 
hard, brown or greenish-brown, resinous, marked with irregular 
concentric circles surrounded by a yellowish alburnum ; splitting 
unevenly, when heated emitting a balsamic odor; taste slightly 



ALTERATIVES. 277 

acrid. It contains from 20 to 25 per cent, of resin, its most 
important constituent. 

Dose. — \- 1 drachm (1.0-4.0 Gm.). 

Official Preparation. 

Guaiacum wood is contained in Decoctum Sarsaparillge Compositum, for which see 
Sarsaparilla. 

Gualaci ResTna— Gualaci Reslnae— Guaiac. U. S. P. 

Origin. — The resin of the wood of Guaiacum officinale. 

Description and Properties. — Irregular masses or subglobular 
pieces, externally greenish-brown, internally of a glassy luster, and 
in recent guaiac usually reddish-brown, transparent in thin splinters, 
fusible, feebly aromatic, the odor becoming stronger upon heating ; 
taste somewhat acrid ; powder grayish, turning green on exposure 
to air. Soluble in potassium or sodium hydrate T. S. and in alco- 
hol, the alcoholic solution being colored blue by the addition of 
tincture of ferric chloride. 

The principal constituents of guaiac resin are — guaiaconic acid, 
guaiacic acid, guaiaretic acid, and a small amount of gum. These 
substances are insoluble in water, but soluble in alkalies. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparations. 

Pilulse Antimonii CompSsitse — Pllulas (ace.) Antimonii Comp6sitas — Com- 
pound Pills of Antimony (Plummer's Pills). — Dose, 1 or 2 pills. 

Tinctura Gualaci — Tincturae Gualaci — Tincture of Guaiac. — Dose, 30-60 
minims (2.0-4.0 Cc). 

Tinctura Gualaci Ammoniata — Tincturae Gualaci Ammoniatae — Ammoni- 
ated Tincture of Guaiac. — Dose, 30-60 minims (2.0-4.0 Cc). 

Unofficial Preparation. 

Emtilsum Gualaci — Emiilsi Gualaci — Guaiac Emulsion. — Dose, \-2 fluid- 
drachms (2.0-8.0 Cc). 

Antagonists and. Incompatibles. — Spirit of nitrous ether and 
the mineral acids are incompatible with guaiac. Water is pharma- 
ceutically incompatible with the tinctures, precipitating the resin. 

Synergists. — Many of the diaphoretics and diuretics aid the 
action of guaiac. Colchicum, sarsaparilla, mezereum, stillingia, 
sassafras, sanguinaria, and xanthoxylum are also synergistic. 

Physiological Action. — Externally and Locally. — Guaiac is 



278 A TEXT-BOOK OF MATERIA MEDICA. 

antiseptic, and possesses mildly astringent properties, being used 
locally as a gargle. 

Internally. — Digestive System. — It increases the flow of saliva 
and gastric juice, producing a sensation of warmth in the epigas- 
trium. It also augments the secretions from the intestinal canal, 
excessive doses even causing vomiting and purging. 

Circulatory System. — Guaiac increases the force and rapidity of 
the heart's action and dilates the cutaneous blood-vessels. 

Nervous System. — No special action has been observed. 

Respiratory System. — The drug is an expectorant, increasing the 
production and excretion of bronchial mucus. 

Absorption and Elimination. — Though a colloidal substance, it 
is absorbed into the blood with considerable facility, being excreted 
chiefly by the skin, exciting free diaphoresis. The bowels, kidneys, 
and bronchial mucous membrane assist in the excretory process. 

Temperature. — Under doses sufficient to cause free diaphoresis 
the temperature may be reduced. Guaiac has, however, no direct 
influence upon the heat-center. 

Uterus. — Large doses of guaiac induce contraction of the womb, 
the drug thus acting as an ecbolic. 

Untoward Action. — No special symptoms are manifest other 
than the gastro-intestinal disturbance mentioned, and occasionally 
headache and giddiness. 

Poisoning. — Guaiac cannot be classed as a poisonous substance. 
Excessive doses act as a gastro-intestinal irritant, although no case 
of death is recorded resulting directly from this drug. 

Treatment of Poisoning. — This should be symptomatic, and 
similar to the treatment of poisoning from colchicum. 

Therapeutics. — Externally and Locally. — Guaiac in some form 
is an excellent application in follicular tonsillitis, rheumatic pharyn- 
gitis, and quinsy. For these cases the emulsion of guaiac serves 
as an efficient gargle, or the troches of guaiac may be used. 

Internally. — From the sixteenth to the eighteenth century 
guaiac was renowned as a cure for syphilis, having been introduced 
into Europe from San Domingo. The heroic manner, however, in 
which the drug was employed rendered the results more injurious 
than beneficial, so that the guaiac treatment was condemned, one 
of its most vigorous opponents being Paracelsus, to whom the 
reintroduction of mercury for the treatment of syphilis is largely 
due. Since we have learned to use mercury and iodine and its 
preparations intelligently the guaiac treatment of this disease pos- 



AL VERA TI VES. 279 

sesses only a historic interest Nevertheless, the drug possesses 
properties which render it exceedingly valuable in chronic muscular 
rheumatism, neuralgic dysmenorrhea, and atonic amenorrhea. 

Guaiac is considered to be an efficient remedy in lumbago and 
chronic gout. Its most important service, however, in therapeutics 
is in the treatment of quinsy. It is doubtful whether there is any 
drug which will modify the course of this disease or abort an 
attack of tonsillitis so readily as this medicine. The tincture of 
guaiac is the preparation usually employed for this purpose, \ 
fluidrachm (2.0 Cc.) being given in the form of an emulsion every 
three or four hours. 

Contraindications. — There are no marked contraindications to 
its use. 

Administration. — The tinctures are very acrid and disagreeable 
to the taste, and should be given in the form of an emulsion. The 
emulsion of guaiac, a formula for which is given in the Dispensa- 
tories, is not unpleasant, and is altogether the best liquid prepara- 
tion to give. 

The lozenges of guaiac, allowed to dissolve slowly in the 
mouth, serve as an agreeable and efficient method of medicating the 
throat with this drug. 

Sarsaparilla— SarsaparUIae— Sarsaparilla. TJ. S. 2*. 

Origin. — The root of Smilax officinalis Kunth and other species 
of Smilax growing in swampy forests in Mexico and as far south 
as the northern portion of Brazil. They are woody climbers, often 
attaining a great height. 

Description and Properties. — About -|- to \ inch (3.17-6.35 
Mm.) thick, very long, cylindrical, longitudinally wrinkled, exter- 
nally grayish- or orange-brown ; internally showing a whitish and 
mealy or somewhat horny cortical layer surrounding a circular 
wood-zone enclosing a broad pith ; nearly inodorous ; taste muci- 
laginous, bitterish, and acrid. The thick, woody, knotty rhizome, 
if present, should be removed. 

Sarsaparilla contains an active principle, parillin, an acrid gluco- 
side which froths with water and otherwise closely resembles sapo- 
nin in its action ; it also contains saponin and sarsa-saponin, two 
glycosides, the latter of which is the most poisonous glycoside in 
the plant. 

Dose. — 30-60 grains (2.0-4.0 Gm.). 



280 A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparations. 

DecSctum Sarsaparillae Comp8situm — Decocti Sarsaparillae Comp6siti — ■ 
Compound Decoction of Sarsaparilla. — Dose, 4-6 fluidounces (118.-178. Cc). 
10 per cent., with Sassafras, Guakc-wood, Glycyrrhiza, and Mezereum. 

Extr&ctum Sarsaparillae Fliiidum — Extracti Sarsaparillae Fluidi — Fluid 
Extract of Sarsaparilla. — Dose, i-2 fluidrachms (2.0-8.0 Cc). 

Extralctum Sarsaparillae Fliiidum Comp6situm — Extracti Sarsaparillae 
Fluidi CompSsiti — Compound Fluid Extract of Sarsaparilla. — Dose, \-z fluid- 
drachms (2.0-8.0 Cc). 

Syrupus Sarsaparillae Comp6situs — Syrupi Sarsaparillae CompSsiti — Com- 
pound Syrup of Sarsaparilla. — Dose, 2-4 fluidrachms (8.0-16.0 Cc). A Fluid 
Extract, 20 per cent., with the Fluid Extracts of Glycyrrhiza and Senna, and the Oils 
of Sassafras, Anise, and Gaultheria. 

Antagonists and Incompatibles. — Alkalies and free iodine are 
incompatible with the official preparations of sarsaparilla. Corro- 
sive sublimate is said to be changed into calomel by the compound 
syrup of sarsaparilla. 

Synergists. — The specifics, diaphoretics, and diuretics. 

Physiological Action. — Sarsaparilla has no local influence. 
Internally its action is similar to that of guaiac, though not so 
energetic and irritant in large doses. 

Therapeutics. — As with guaiac, the history of sarsaparilla is 
full of interest. Introduced into Europe in the sixteenth century 
by the Spaniards, who had learned of its alleged virtues in consti- 
tutional syphilis in Peru, San Domingo, and Brazil, it retained its 
reputation as a specific in this disease for a century or more, when 
it was abandoned, only to be revived at the close of the eighteenth 
century. Since that time it has retained its place in medicine more 
through the wonderful virtues ascribed to it by nostrum-venders 
than to any real medicinal properties which it possesses. 

The consensus of competent opinion seems to be that sarsa- 
parilla can claim no special medicinal virtues other than its diuretic 
and diaphoretic properties. 

The compound decoction of sarsaparilla is probably the most 
useful official preparation, and appears to have been of some bene- 
fit in scrofula and strumous cutaneous affections. Indeed, some 
cases of constitutional syphilis have improved more rapidly under 
the administration of this preparation than when mercury or potas- 
sium iodide has been given alone. 

Contraindications.— There are none. 

Administration. — No special directions can be given for the 
administration of the various preparations. The compound syrup 



ALTERATIVES. 281 

of sarsaparilla is quite pleasant to the taste, and is used extensively 
as a vehicle, particularly for potassium iodide. 



Stillingia— Stillingiae— Stillingia. 77. S. P. 

(Queen's Root.) 

Origin. — The root of Stillingia sylvatica L., a perennial herb 
growing in dry and sandy soil in the Southern United States as 
far north as Eastern Virginia. 

Description and Properties. — About I foot (30 Cm.) long and 
nearly 2 inches (5 Cm.) thick, subcylindrical, slightly branched, 
compact, wrinkled, tough, grayish-brown, breaking with a fibrous 
fracture, showing a thick bark and porous wood, inner bark and 
medullary rays having numerous yellowish-brown resin-cells. 
The odor is peculiar and unpleasant; the taste bitter, acrid, and 
pungent. 

It contains an acrid resin, sylvacrol, a volatile and a fixed oil, 
starch, gum, tannin, and a glycoside. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

Official Preparation. 

Extractum Stilllngiae Fluidum— Extraxti Stillingiae Fluidi— Fluid Extract 
of Stillingia. — Dose, |-i fluidrachm (1.0-4.0 Cc). 

Unofficial Preparatio?is. 

Dec6ctum Stillingiae — Dec6cti Stillingiae — Decoction of Stillingia. — Dose, 
1-2 fluidounces (30-60 Cc). 

Extraxtum Stillingiae Fluidum Comp6situm — Extraxti Stillingiae Fluidi 
Comp6siti — Compound Fluid Extract of Stillingia. — Dose, 1-2 fluidrachms (4.0- 
8.0 Cc). Stillingia, 130; Corydalis, 130; Chimaphila, 60; Iris, 60 ; Sambucus, 60; 
Xanthoxylum Berries, 30; and Coriander, 30; to make 500 parts Fluid Extract with 
Dilute Alcohol. 

Syrupus Stillingiae CompSsitus— Syrupi Stillingiae Compdsiti— Compound 
Syrup of Stillingia. — Dose, 1 fluidrachm to 1 ounce (4.0-30 Cc). Compound Fluid 
Extract, I, to Simple Syrup, 3 parts. 

Tinctura Stillingiae — Tincturae Stillingiae— Tincture of Stillingia.— Dose, 
|-i fluidrachm (2.0-4.0 Cc). 

Antagonists and Incompatibles. — There are none affecting 
Stillingia. 

Synergists. — The same as for sarsaparilla. 

Physiological Action. — The action of stillingia resembles that 
of sarsaparilla, the drug increasing the various secretions and stim- 
ulating the heart and circulation. 



282 A TEXT-BOOK OF MATERIA MEDICA. 

Therapeutics. — The medical uses are the same as those of 
sarsaparilla. 

Sanguinaria— Sanguinariae— Sanguinaria. U. 8. J\ 

(Blood-root.) 

Origin. — The rhizome of Sangidnaria Canadensis L., a low 
perennial, a native of Canada and the United States, where it grows 
in open woods in a rich soil. The rhizome should be collected in 
autumn. 

Description and Properties. — Of horizontal growth, about 2 
inches (5 Cm.) long and §■ inch (1 Cm.) thick, cylindrical, some- 
what branched, slightly annulate, wrinkled, reddish-brown ; frac- 
ture short, somewhat waxy, whitish, with numerous small red 
resin-cells, or of a nearly uniform, brownish-red color ; bark thin ; 
odor slight ; taste persistently bitter and acrid. It contains a color- 
less alkaloid, sanguinarine, yielding red salts ; chelerythine, yield- 
ing lemon-yellow salts ; homochelidonine ; and protopine. 

These alkaloids are closely related to the opium series. 

Dose. — 2-20 grains (0.12- 1.2 Gm.). 

Official Preparations. 

Extralctum Sanguinariae Fluidum — Extracti Sanguinariae Fluidi — Fluid 
Extract of Sanguinaria. — Dose, 5-15 minims (0.3-1.0 Cc). 

Tinctura Sanguinariae (15 percent.) — Tincturas Sanguinariae — Tincture of 
Sanguinaria. — Dose, 10-60 minims (0.6-4.0 Cc). 

Unofficial Preparations. 

Acetum Sanguinariae — Aceti Sanguinariae — Vinegar of Sanguinaria. — Dose, 
15-40 minims (1.0-2.5 Cc) ; as an emetic, 1-4 fluidrachms (4.0-16.0 Cc). 
Sanguinarine Nitrate. — Dose, T V~i g ram (0.005-0.008 Gm.). 

Antagonists and Incompatibles. — The irritation and circu- 
latory depression occasioned by blood-root are antagonized by 
opium, atropine, etc., while the incompatibles are tannic and gallic 
acids, alkalies, and metallic salts. 

Synergists. — The Specifics and the mineral and vegetable 
emetics aid the action of sanguinaria. 

Physiological Action. — Externally and Locally. — Sanguinaria 
is an irritant and a feeble escharotic. When the powder of blood- 
root is inhaled it produces great irritation of the respiratory pas- 
sages, with excessive secretion and violent sneezing. 

Internally. — Digestive System. — Medicinal doses occasion a 



AL TERA TI VES. 283 

sense of constriction in the throat and heat in the epigastrium, 
increasing the secretions from the stomach, liver, and intestines. 
Excessive doses are followed by marked salivation, nausea, and 
vomiting, the drug acting as a systemic emetic. Very large doses 
cause great irritation of the intestines, producing hypercatharsis. 

Circulatory System. — At first the heart's action is increased and 
arterial tension raised, but these effects are followed by cardiac and 
circulatory depression. Poisonous doses sometimes result in car- 
diac paralysis. 

Nervous System. — Large doses diminish reflex excitability by 
paralysis of the spinal centers, occasionally producing convulsions 
of spinal origin. 

Respiratory System. — Medicinal doses of sanguinaria have no 
apparent effect upon the respiration ; poisonous doses, however, 
render the breathing slow and shallow, death resulting from as- 
phyxia due to paralysis of the respiratory center. The final col- 
lapse is often preceded by convulsions arising from the accumulation 
of carbon dioxide in the blood from failure of respiration. 

Blood-root is a stimulant expectorant, increasing the secretion 
from the broncho-pulmonary mucous membrane. 

Absorption and Elimination. — The drug is quite rapidly ab- 
sorbed, and is eliminated by the intestines, stomach, skin, kidneys, 
and bronchial mucous membrane. 

Temperature. — Medicinal doses have no effect upon, but. exces- 
sive doses lower, the temperature. 

Eye. — Poisonous doses produce dilatation of the pupils. 

Uterus. — Sanguinaria possesses emmenagogue properties. 

Untoward Action. — This does not differ from the poisonous 
action which follows. 

Poisoning. — Blood-root is an acro-narcotic poison, exciting sali- 
vation, violent vomiting, profuse watery evacuations from the 
bowels, and producing all the symptoms of gastro-enteritis. The 
muscular system is greatly relaxed, the pulse is slow, weak, and 
irregular, the skin covered with cold sweat, and finally collapse of 
the vital powers supervenes. Convulsions may precede a fatal termi- 
nation, which is due to paralysis of the respiratory or cardiac center. 

Treatment of Poisoning. — The stomach should be washed out 
and diffusible stimulants freely given. Strychnine may be admin- 
istered hypodermically, and digitalis and amyl nitrite given if 
necessary. The pain and nausea may be relieved by morphine and 
atropine. The normal temperature of the body should be main- 
tained by external warmth. 



284 A TEXT-BOOK OF MATERIA MEDICA. 

Therapeutics. — Externally and Locally. — The nitrate of san- 
guinarine — \ grain (0.015 Gm.) to 1 ounce (30 Cc.) of glycerin — 
has been recommended by Keyser in conjunctivitis granulosa. The 
powdered blood-root has been employed as a sternutatory, and 
when mixed with two or three times the amount of powdered 
acacia or starch it has proved beneficial, in the hands of some 
physicians, in the dry form of atrophic rhinitis. The pure powder 
is said to be an efficient escharotic to nasal polypi and fungoid con- 
ditions of the mucous membrane. 

This drug is now seldom used locally, the irritation caused by 
it being so great that patients can only with great difficulty be per- 
suaded to submit to the treatment 

Internally. — While possessing alterative properties and classed 
among the Specifics, one of the principal uses of sanguinaria is in 
acute bronchitis, when the spasmodic element predominates and 
after the subsidence of the more acute symptoms. 

In atonic conditions of the stomach and bowels, with increased 
secretion of mucus, small doses of tincture of sanguinaria prove 
beneficial. The tincture is of equal value in duodenal catarrh with 
jaundice. 

As an emmenagogue and aphrodisiac blood-root has been suc- 
cessfully employed in functional amenorrhea and dysmenorrhea, as 
well as in functional impotence with relaxation of the genital organs 
and daily seminal losses. 

Sanguinarine has been recommended in hysteria, either alone 
or associated with podophyllum. Protracted muscular rheumatism 
has apparently been benefited by this drug. 

Contraindications. — No special contraindication exists, unless 
it be an acute inflammatory condition of the stomach and bowels. 

Administration. — The nitrate of sanguinarine is the best prepa- 
ration to use in diseases of the respiratory tract. As a gargle the 
vinegar of sanguinaria is to be preferred, while, if the drug is to be 
employed as an emetic, the infusion, given in tablespoonful doses 
at short intervals, serves the best purpose. For other purposes 
the tincture is the most desirable preparation. 

The sanguinarine nitrate is best administered in pill form ; the 
liquid preparations should be given well diluted with water. 

Mezereum— Mezerei— Mezereon.— U. S. P. 

Origin.' — The bark of Daphne Mezereum L. and other species 
of Daphne, small shrubs about 2-4 feet (0.6-1.2 M.) high, indige- 



AL TERA TIVES. 285 

nous in hilly and mountainous regions of Europe, extending to 
the Arctic .Circle and eastward to Siberia. 

Description and Properties. — Long, thin bands, usually folded 
or rolled into disks, the outer surface yellowish or brownish-yellow, 
with transverse scars and minute blackish dots, underneath of a 
light greenish color; inner surface whitish, silky. Bast in trans- 
verse layers, very tough ; inodorous ; taste very acrid. The im- 
portant constituent is an acrid resin, mezerein ; it also contains a 
crystalline glucoside, daphnin. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Official Preparation. 

Extractum Mezerei Fluidum — Extr&cti Mezerei Fluidi — Fluid Extract of 
Mezereon. — Dose, 1-5 minims (0.06-0.3 Cc). Mezereon is also one of the ingredi- 
ents in Decoctum Sarsaparillse Compositum, Extractum Sarsaparillse Fluidum Composi- 
tum, and Linimentum Sinapis Compositum. 

Antagonists and Incompatibles. — The glucoside is precipi- 
tated by tannic and free acids, and the resin by water, in which it 
is insoluble. 

Synergists. — All the vegetable specifics, with the exception of 
colchicum. 

Physiological Action. — Its action, both locally and internally, 
is quite similar to that of sanguinaria, but when applied to the 
skin it is more of a vesicant than an escharotic, and taken inter- 
nally it is more of a diuretic than sanguinaria, in poisonous doses 
causing severe urinary irritation and other symptoms produced by 
a violent gastro-intestinal irritant. The treatment of poisoning 
would be the same as that prescribed under poisoning by sanguin- 
aria. 

Therapeutics. — It is a counter-irritant in the form of an oint- 
ment. Internally it is now seldom if ever used alone, but in com- 
bination with other vegetable specifics it is prescribed in chronic 
rheumatism and in chronic syphilitic and non-syphilitic cutaneous 
diseases. 

Contraindications. — Acute inflammation of the stomach, bow- 
els, and kidneys. 

Administration. — As it is never given internally alone, no spe- 
cial instructions for its administration are necessary. The fluid 
extract freely diluted with water would, however, be the only 
preparation to use. 



286 A TEXT-BOOK OF MA TERIA MEDICA. 

Xanthoxylum— Xanthoxyli— Xanthoxylum. U. S. -P. 

(Prickly Ash.) 

Origin. — The bark of Xanthoxylum Americanum Miller and of 
Xanthoxylum Clava-Herculis L. Both species are native to North 
America, the first being shrubby and attaining a height of 10 or 
12 feet (3-3.6 M.), while the second species is a small tree some- 
times 30 or 40 feet (9-12 M.) high. 

Description and Properties. — Xanthoxylum Americanum 
(Northern Prickly Ash) occurs in curved or quilled fragments 
about yV mcn ( r Mm.) thick ; outer surface brownish-gray, with 
whitish patches and minute black dots, slightly furrowed, with 
some brown, glossy, straight, two-edged spines, linear at the base 
and about \ inch (6 Mm.) long; inner surface whitish, smooth; 
fracture short, non-fibrous, green in the outer and yellowish in the 
inner layer ; inodorous ; taste bitterish, very pungent. Xanthoxy- 
lum Clava-Herculis (Southern Prickly Ash) resembles the preced- 
ing, but is about -^ inch (2 Mm.) thick, and is marked by many 
conical, corky projections, sometimes £ inch (2 Cm.) high, and by 
stout brown spines rising from a corky base. 

Xanthoxylum should not be confounded with the bark of 
Aralia spinosa L., which is nearly smooth externally, and beset 
with slender prickles in transverse rows. 

Prickly ash contains an acrid green oil, a colorless, crystalline 
resin, a bitter principle, sugar, ash, and tannic acid. 

Dose. — 10-30 grains (0.6-2.0 Gm.j. 

Official Preparation. 

Extr^ctum XanthSxyli Fluidum— ExtrScti XanthSxyli Fluidi — Fluid Ex- 
tract of Xanthoxylum. — Dose, 10-30 minims (0.6-2.0 Cc). 

Physiological Action. — The action of xanthoxylum is quite 
similar to that of sanguinaria, though it is more of a stomachic 
tonic, sialagogue, diuretic, and diaphoretic, and not so much of a 
local irritant. It increases the heart's action and raises arterial 
tension. 

Therapeutics. — It is used locally as a masticatory for the same 
purposes as mezereon, and the decoction has been highly recom- 
mended as a gargle in chronic pharyngitis. 

Internally its medical uses are the same as those of stillingia, 
mezereon, etc., although of more value in atonic dyspepsia. 



AL TERA TI VES. 287 

Contraindications and Administration are the same as for 
sanguinaria. 

Serum-therapy. 

Among the marvels of scientific research which have distin- 
guished our century no achievements are more remarkable, nor 
of greater moment to the welfare of mankind, than those pertain- 
ing to the field of biological, pathological, and therapeutic inves- 
tigation. Yet, brilliant as have hitherto been the triumphs of 
speculative thought and the deductions drawn from tireless ex- 
perimentation and practically applied to the curative art, the highest 
generalizations and most signal exhibitions of genius are perhaps 
related to the special phenomena revealed by the study of zymotic 
diseases. The limits of the present work preclude a detailed treat- 
ment of so extensive and complicated a subject; yet a brief sum- 
mary, elucidating the theory and development of serum-therapy as 
exemplified in contemporaneous research, should be of interest 
as well as benefit to the student of modern therapeutics. 

A glance at the history of therapeutic procedure in the prophy- 
lactic treatment of infectious diseases shows that the general prin- 
ciple underlying all later discoveries was, however crudely, divined 
at a much earlier period than we are wont to suppose. In view 
of actual attainment it is natural that the mind should revert to 
the transcendent services rendered to mankind by Jenner ; yet it is 
known that the ancient Hindus and Persians, as well as the nomad 
tribes and caravans of Farther Asia, practised inoculation of equine 
virus, or horse-pox — the mammary pustule developed during early 
lactation in the horse, camel, and cow, and even in woman. 

The inoculation of human virus is of immemorial origin, proba- 
bly coeval with the importation of variola from Asia into Africa by 
the Saracens. Certain it is that as early as the tenth century the 
Arabs and Chinese adopted the custom of variolization, the inoc- 
ulation of small-pox, although the skeptical physicians of the age 
consigned the practice as a monopoly to women. 

In 17 17, Lady Montague, wife of the British ambassador at 
Constantinople, saw an old Thessalian woman whose immunity so 
impressed her that she practised the operation upon her own child. 
Writing from Adrianople, she says : " They take the small-pox 
here for diversion ; I have tried it on my dear little son ; I am 
going to bring this useful invention into fashion in England." In 



2 88 A TEXT-BOOK OF MATERIA MEDICA. 

171 8 her desire was realized, King George II. adopting the practice 
in the royal family. Three years later the custom was introduced in 
France, being accepted by Chirac and Helvetius, although the 
decrees of the Sorbonne and the Faculty of Medicine condemned 
the innovation as " illicite et contraire a la loi de Dieu ;" notwith- 
standing which official malediction the practice of inoculation con- 
tinued to spread until supplanted by vaccination proper in 1800. 
The French peasants knew in the last century that the act of milk- 
ing cows infected with mammary pustule, where there was any 
lesion of the epidermis on the hands, conferred immunity against 
small-pox ; and the mountaineers have long been accustomed to 
collect the crusts resulting from vaccine disease, macerating them 
in water, and inoculating their children with the solution. 

The success attending these rude experiments in France was 
communicated by a Frenchman, Rabault, in 1768, to Dr. Pew, an 
English physician, who reported the matter to his friend Jenner, 
who at once perceived the momentous import of the discovery. 
Meanwhile, in 1771, a Holstein schoolmaster vaccinated three 
pupils; and in 1774 an English farmer, having observed the pro- 
tection existing among his dairymaids, and having implicit con- 
fidence in the efficacy derived from inoculation of bovine virus, 
vaccinated his wife. 

It was reserved for Jenner, however, in 1 yj6, to commence the 
systematic and exhaustive study of the subject destined to prove 
inestimably beneficial to mankind. It was, in truth, the year 
celebrated for his declaration of scientific independence, which, 
after long contumely and scurrilous ridicule, was to wrest from his 
humiliated adversaries every weapon of derision and reproach. 

His early experiments were but a repetition of the empirical yet 
prophetic test of the English farmer ; yet with his gifted insight 
and indomitable courage the field of discovery was greatly ampli- 
fied, the results being in accordance with scientific methods inspired 
by Jenner's originality and force. 

He found in the northern counties of England a certain form of 
ulcer upon the hands of those employed in dairies and immune 
against small-pox; observed that the malady resembled the pus- 
tules affecting the udder of the cow, having apparently been occa- 
sioned by contact; vaccinated an individual supposed to be un- 
protected against the disease, and subsequently exposed him to 
infection with triumphant impunity. A long interval of laborious 
investigation had led to this final test, and it was not until 1798 



ALTERATIVES. 289 

that Jenner published his first paper upon the subject, vaccination 
being transported to America in the following year. 

Such is the brief yet eloquent record of an achievement which 
experience has proved to be of incalculable benefit to man. To- 
day there is no question among the more enlightened members of 
the profession that the operation, properly performed, is an absolute 
safeguard against the infection of small-pox. 

Strange indeed is it that a century of comparative quiescence 
should have elapsed since Jenner pointed the way to the startling 
accomplishment of the present epoch. Yet not until Pasteur, in 
1880, announced to the world the issue of his labors touching the 
protective inoculation of animals was the broken thread of patho- 
genic research taken up anew, and the task of solving its mysteries 
resumed — be it said with profounder acumen and far more com- 
plete appliances than ever before. 

It is a matter of record how the French savant demonstrated 
that cultures of the bacilli of chicken-cholera, when thoroughly 
dried and long exposed to the air, lost their virulence, and that 
fowls inoculated with the attenuated virus were rendered insensible 
to the attacks of more energetic micro-organisms. It was, mutatis 
mutandis, a modification or development of the Jennerian principle : 
" The history of vaccination constitutes the first step in a long 
series of labors inspired by the admirable discoveries originating in 
the geuius of Pasteur. The principle is always the same — to 
diminish the strength of the virus and inject it into the animal 
which we wish to render immune " (Bernheim). Yet in the far- 
reaching possibilities suggested by Pasteur's experiments the 
present was immeasurably in advance of previous attainment. 

The further application of this discovery to other animal infec- 
tions confirmed by indisputable evidence the validity of the savant's 
theories and the efficacy of their practical illustration. A new 
light was shed upon pathogenic study ; all Europe felt the impulse 
given to scientific thought in its relation to therapeutic progress, 
and in the sanctum of the laboratory many a fervent recluse sought 
to amplify the knowledge already attained. 

A striking departure from Pasteur's method by Salmon and 
Smith, in 1886-87, led indirectly to the latest evolution of inocula- 
tive therapy. They showed conclusively that animals may be ren- 
dered immune against certain infectious diseases by inoculating 
them with filtered cultures containing the toxic products of patho- 
genic micro-organisms entirely free from the living bacteria to 
19 



290 A TEXT-BOOK OF MATERIA MEDICA. 

which they owe their origin. By this process immunity against 
the bacillus of hog-cholera was attained in pigeons, the disease 
being almost invariably fatal to these birds. A little later (1888) 
Roux, employing similar sterilized cultures, succeeded in protect- 
ing susceptible animals against the anthrax bacillus ; and more 
recently (1890) Behring and Kitasato have proved that immunity 
against the action of the tetanus bacillus may be conferred by the 
use of toxic products in solution freed from the presence of active 
germs — in a word, that purely chemical agents sufficed to attain the 
object hitherto deemed wholly dependent upon the influence of 
living bacteria. The significance of this discovery could hardly be 
over-estimated. By it the entire theory of causal phenomena — the 
protective force in which the immunizing property was supposed 
to reside — became modified. If not a living organism, but a chemi- 
cal substance, proved to be the immunizing agent, then resistance 
to toxic influences must proceed from some source other than bac- 
terial metabolism, some organic force inherent in the inoculated 
system. To ascertain the nature and operation of this bactericidal 
power and determine the rationale of acquired immunity now 
engaged the earnest attention of savants throughout the world. 

It was soon found that the lymph and blood of a normally 
healthy organism possessed in a degree this mysterious property 
of neutralizing the toxic effects of bacterial action, and gradually 
the truth which had thus far eluded the most searching investiga- 
tion was revealed. Finally, by a series of experiments involving 
the rarest skill and discrimination, the resistant energy developed 
by the infected organism was traced to certain albuminoids pertain- 
ing to or dissolved in the blood-serum, the acute and comprehen- 
sive insight of Behring, especially, sustaining the new hypothesis, 
which speedily passed from the realm of conjecture to the assurance 
of experimental proof, culminating in the establishment of serum- 
therapy as a legitimate and auspicious field of therapeutic science. 
It should be observed that the remarkable discoveries of Koch in 
his chosen domain of bacteriology had exercised no little influence 
in guiding and confirming the wider researches of his successors. 

Before entering upon a consideration of practical details it 
should be stated that the theory and practice of serum-therapy 
are based upon the condition of the system, whether in man or the 
lower animals, which renders it inhibitive of bacterial development 
by opposing an effective barrier to the propagation of pathogenic 
germs. This self-protective antagonism pertaining to the indi- 



AL TERA TI VES. 2 9 1 

vidual organism is termed immunity, and may be either natural or 
acquired. 

By natural immunity is understood the absence of all personal 
predisposition toward certain infections or diseases, even under the 
most favorable exposure. A familiar example of this inherent, 
congenital unsusceptibility is found in poisoning by various species 
of Rhus, some persons handling the plants and even chewing the 
leaves with impunity, while upon others the mere proximity of the 
poison has a toxic effect. 

Acquired immunity may be either accidental or artificial. In 
the former case protection is secured by a previous access of the 
disease — as, for instance, a child recovered from scarlet fever, who 
is rarely prone to a second attack. In the latter case the suscept- 
ibility is obviated by protective inoculation, it being known, to illus- 
trate, that an animal inoculated by injections of anthrax-poison is, 
after recovery from transient symptoms of disease, rendered arti- 
ficially immune — a fact demonstrated by the thoroughly scientific 
experiments of Pasteur. 

An eminent authority, Schleich, has declared that natural or 
spontaneous immunity does not exist, but that the protective qual- 
ity is created by the animal kingdom — either through a previous 
malady or, as more frequently happens, through transmission from 
progenitors to offspring. Syphilis or tuberculosis in parents, he 
maintains, confers upon children immunity from these diseases ; 
and the author cites in support of his theory that certain infections, 
such as plague and leprosy, have wholly disappeared from various 
countries because of the inoculation of succeeding generations and 
the consequent attenuation of the virus — exhaustion of the soil, as 
it were. Bernheim asserts that no animal is endowed with absolute 
immunity, but that, however strong may be the resistance of the 
particular organism, it must succumb to an excessive invasion of 
microbes or of toxic products. 

The doctrine of immunity has, not inaptly, been styled the 
theorem of which serum-therapy is the logical corollary ; yet it is 
only within a few years that the mystery which shrouded the entire 
subject has been dispelled. To-day, thanks to untiring researches 
in the fields of physiology, biology, and chemistry, we are ac- 
quainted, if not with its precise nature and origin, at least with 
many details intimately associated with its causation. Formerly 
supposed to be absolute in its relation to species and individuals, 
we now recognize that immunity is but relative, considerations of 



292 A TEXT-BOOK OF MATERIA MEDICA. 

climate, race, receptivity, character of pathogenic germs, and con- 
ditions of infection all entering as modifying factors into the devel- 
opment and exercise of this potent yet complex force. 

Chauveau has shown that Algerian sheep, relatively immune 
against anthrax, contract the disease under enormous hypodermic 
injections of culture ; on the other hand, a slight puncture of the 
aural epidermis is fatal to sheep in France, which, transported to 
Algeria, succumb to natural infection. Watson-Cheyne states that 
a single virulent bacillus may cause the death of a guinea-pig or 
induce septicemia in the mouse, provided these animals be pecu- 
liarly susceptible. Yet the guinea-pig is not affected by the injec- 
tion of a few bacilli from a septicemic mouse, while several thou- 
sands occasion only an abscess, although death ensues with higher 
dosage. Again, young white mice are quickly killed by the anthrax 
bacillus, while the same injection produces in the old only a local 
lesion. Cattle, though more amenable to infectious disease than 
sheep, are but slightly affected by hypodermic injections. Hogs 
are but slightly sensitive to anthrax, while the immunity of car- 
nivora is proverbial. Meat infected with anthrax is innocuous to 
the dog, the cat, and the fox. 

Again, anthrax has but little influence upon birds or fowls, 
especially chickens, yet it has proved fatal to sparrows and pigeons ; 
and Pasteur overcame the immunity of chickens by plunging their 
feet in water, heat and cold, according to M. Roger, predisposing 
animals to infection, less by moderating bodily temperature than 
by disturbing the general economy and diminishing the power of 
resistance. 

As with anthrax, so in the case of glanders, peculiar to horses 
— the varying susceptibility to infectious diseases is apparent, bo- 
vine animals being wholly immune, and the hog, dog, singing- 
birds, and pigeons but slightly affected. 

In tuberculosis experimental injection of the same culture is 
followed by results widely diverse, certain animals being seized 
with acute tuberculosis, while others show marked resistance to the 
poison, although under excessive doses none is completely immune. 
In this connection it may be noted that clinical experience demon- 
strates the same pathological diversity in human beings. The 
goat, dog, ass, and sheep are rarely affected by tuberculous disease, 
yet all are susceptible to pathogenic inoculation. The monkey, 
seldom contracting the disease in his native haunts, becomes upon 
transportation remarkably prone to phthisical affections. With the 






ALTERATIVES. 293 

exception of the dog, most of the carnivora are easily influenced 
by tuberculous contagion. On the other hand, cold-blooded ani- 
mals are singularly immune, inoculation of toxic germs producing 
no development of the disease, though fatal results may occur 
from systemic intoxication. 

These examples, which might be multiplied indefinitely, suffice 
to show the relative character of natural immunity. It may be 
added that the caprice of toxic infection becomes even more appa- 
rent in studying the physiological and pathological conditions of 
the same organism when subject to the modifying influences of 
climate, altitude, seasons, heat, cold, traumatism, diet, ventilation, 
etc., and the subjective considerations of age, sex, race, fatigue, 
splenetic influence, nervous lesions, alcoholism, auto-intoxication, 
and acquired or hereditary diathesis. Indeed, the pathological 
records of disease abound in curious, often inexplicable, data 
touching individual and racial immunity. The subject is important 
in its bearing upon serum-therapy, and furnishes a theme of profit- 
able study in its relation to the practical treatment of infectious 
disease. 

With regard to the rationale of immunity, the theories advanced 
in explanation of this occult yet indubitable force are many, and 
often greatly at variance. Eliminating those which may be re- 
garded as too fantastic for serious consideration, the more plausible 
conjectures refer the phenomena in question to cellular, chemical, 
chemico-cellular, and vaso-motor agencies. 

Prominent among competent opinions is the doctrine of pliago- 
cytosis proposed by Metschnikoff. 

In 1883 Metschnikoff established the existence of an intracellular 
digestion, showing that nomad cells were capable of absorbing vege- 
table filaments ; that mesodermic protoplasm possessed the same 
power over bacteria ; and that in the higher animals this phagocytic 
function had its analogue in the digestive property of leucocytes, 
or white blood-corpuscles. Gluge observed that in hemorrhage 
of the nervous centers these corpuscles digest the disintegrated 
myelin, and in a fresh-water crustacean, daphne, they have been 
seen to gather about the spores of algae, penetrating the meso- 
derm. 

Metschnikoff multiplied these examples of cellular defence 
among invertebrates, distinguishing two sorts of leucocytes : the 
stationary (macrophages) and the mobile (microphages), the latter 
including the white globules of lymph, and especially of blood, of 



294 A TEXT-BOOK OF MA TERIA MEDICA. 

which, together, they constitute about 20 per cent. It may be 
said that all organs contain elements of defence — macrophages. 

The experiments of Gabritschevsky, who has studied phagocy- 
tosis in diphtheria, are highly instructive. Injecting a pure culture 
of Loeffler's bacillus into the anterior chamber of a rabbit's eye, he 
saw the devastation wrought among the leucocytes, which appeared 
powerless to contend against the deadly germs. But after immu- 
nizing the rabbit with attenuated cultures previous to the injection 
of toxic bacilli, a battle-royal ensued, the phagocytic action of the 
leucocytes resulting in the signal triumph of the latter, so that at 
the end of eight hours not a single free bacillus was found in the 
chamber, all having been absorbed within the opposing globules. 

Yet, notwithstanding the plausibility of Metschnikoff's hypothe- 
sis and the striking significance of his experiments — embracing in 
epitome the whole theory of preventive inoculation — certain argu- 
ments of Behring and Kitasato, based upon experimental research, 
go far to disprove the validity of the doctrine he so zealously 
maintained. Still, although the substances which form the defen- 
sive property of phagocytes, and are so fatal to the pathogenic 
action of microbes, remain unknown to us, the fact of phagocyto- 
sis cannot be denied. 

It was natural in the light of new developments that investiga- 
tion should inquire whether the leucocytes constituted the only 
protective force within the organism. Then followed the theory 
that the humors in general possess microbicidal power — either 
through the presence of destructive elements and the secretion of 
soluble toxins or through the chemical capacity of withdrawing 
oxygen from the invading micro-organisms. To Buchner is chiefly 
due the early elucidation of the chemical theory, and of first recog^- 
nizing in serum bactericidal properties, he being followed by Behring, 
to whom is to be credited the more important labor of extending 
experimentation and proving that animals naturally immune against 
a certain disease may furnish serum endued with neutralizing power. 
Behring found that the blood and blood-serum of the rat, which 
is naturally immune against anthrax, possesses strong bactericidal 
properties, while those of mice, cattle, etc., very susceptible to anthrax 
infection, have none. 

Further research resulted in Behring's all-important law, es- 
tablished by searching experiment, that "the blood and blood- 
serum of an individual which has been rendered artificially immune 
against a certain infectious disease may be transferred into another 



AL TERA TI VES. 295 

individual, with the effect of rendering the latter also immune, no 
matter how susceptible this animal is to the disease in question." 
This formulated doctrine became the fundamental motive in all 
future investigations, the culminating achievement of inoculative 
therapy being the announcement of Behring and Kitasato in 1890 
concerning the artificial immunity against tetanus and diphtheria 
conferred by blood-serum, including the first emphatic declaration 
that the power of rabbits and mice when rendered immune to re- 
sist tetanus-poisoning "is based upon the ability of blood-serum to 
neutralize the toxins produced by the tetanus bacilli." As Krieger 
well observes : " These toxins are the poisonous products of bac- 
terial metabolism, and are the causes of acute disease when circu- 
lating in the organism. Their effect is an intoxication of the system, 
while after the introduction of virulent germs the cause of the dis- 
ease is an infection ." 

An antitoxin is not the direct result of bacterial action, but is 
properly described as an unknown body resulting from the resist- 
ance of a healthy organism to the toxins of pathogenic bacteria. In 
practice this antitoxic body comes to us in the blood-serum of 
animals, usually the horse. When properly prepared and properly 
kept in aseptic containers the antitoxins are not at all dangerous — in 
fact, are as innocuous as an equal amount of blood-serum or normal 
salt solution administered in the same way. We use antitoxins to 
resist the effects of infection with pathogenic bacteria because the 
results of such infection are due to the toxins elaborated by those 
bacteria, and not to the bacteria themselves. These antitoxins do 
not destroy the bacteria ; in other words, they are not germicides. 
In fact, the antitoxic serums are themselves good culture-media. 
One theory of their action is that they neutralize the toxin, thus 
giving the natural bactericidal powers of the body an opportunity 
to exercise their function. 

In support of the proposition that the symptoms in infectious 
diseases are due to the toxins elaborated by the bacteria, and not to 
the bacteria themselves, the following quotation from the last edition 
of Sternberg's Manual of Bacteriology is given : " Certain sapro- 
phytic bacteria, when injected beneath the skin of a susceptible 
animal, multiply at the point of inoculation and invade the sur- 
rounding tissues, giving rise in some instances to the formation of 
a local abscess, in others to an infiltration of the tissues with bloody 
serum, and in others to extensive necrotic changes. These local 
changes are due not simply to the mechanical presence of the 



296 A TEXT-BOOK OF MATERIA MEDICA. 

micro-organisms which induce them, but to chemical products 
evolved during the growth of these pathogenic bacteria. Indeed, 
their pathogenic power evidently depends, in some instances at 
least, upon these toxic products of their growth, by which the vital 
resisting power of the tissues is overcome. Other bacteria, while 
they develop chiefly in the vicinity of the point of entrance — by 
accident or by inoculation — produce a potent toxic substance 
which gives rise to general symptoms of a serious character, such 
as tetanic convulsions (bacillus of tetanus), or intense fever and 
nervous phenomena (micrococcus of erysipelas). The pus cocci 
and various other saprophytic bacteria when introduced beneath 
the skin give rise to the inflammation of abscesses, unattended by 
any very considerable general disturbance, and also to secondary 
purulent accumulations — metastatic abscesses. 

" That this is not due simply to their mechanical presence is 
shown by the fact that powdered glass and other inert substances, 
when thoroughly sterilized, do not give rise to pus-formation when 
introduced beneath the skin or when injected into the cavity of the 
abdomen. On the other hand, it has been demonstrated by the 
experiments of Grawitz, De Bary, and others that certain chemical 
substances which act as local irritants when brought in contact with 
the tissues may induce pus-formation quite independently of micro- 
organisms ; nitrate of silver, oil of turpentine, and strong liquor 
ammoniae have been shown to possess this power. And it has been 
demonstrated by the recent experiments of Buchner that sterilized 
cultures of a long list of different bacteria — seventeen species tested 
— give rise to suppuration when introduced into the subcutaneous 
tissues. 

" In diphtheritic inflammation of mucous membranes we have a 
local invasion of the tissues and a characteristic plastic exudation. 
In true diphtheria the local inflammation and necrotic changes in 
the invaded tissues are not sufficient to account for the serious 
general symptoms, and we now have experimental evidence that 
the diphtheria bacillus produces a very potent toxic substance, to 
which these symptoms are no doubt largely due. The diphtheria 
bacillus of Loffler appears to be the cause of the fatal malady 
which goes by this name, but undoubtedly other micro-organisms 
may be concerned in the formation of diphtheritic false membrane." 

In addition to this valuable information afforded us by Dr. 
Sternberg, additional evidence as to the correctness of this conclu- 
sion is the fact that horses while being immunized give the classical 






AL TERA TIVES. 297 

constitutional symptoms of each disease, though they are treated 
with the filtered toxin, which contains no bacteria whatever. A 
possible exception may be made of anthrax, though Sternberg dis- 
tinctly states that it acts in the same way. 

As to the therapeutic action of antitoxin, little or nothing is 
known positively ; it seems reasonable to conclude from experimen- 
tal evidence that the antitoxin neutralizes the toxin in the body 
and thereby gives the natural germicidal powers an opportunity to 
dispose of the bacteria. It may be that it has the additional prop- 
erty of stimulating the phagocytic and possibly other bactericidal 
functions. The following experiments made by Messrs. Martin 
and Cherry in England, and described in an editorial in the Journal 
of the American Medical Association of August 27, 1898, will be 
of interest in this connection. Behring, Ehrlich, and Kanthack 
have advocated the theory that the antagonism between toxins and 
antitoxins is a chemic one, somewhat analogous to the neutraliza- 
tion of an acid by an alkali ; while Buchner, Metchnikofif, and others 
have maintained that it is indirect and operates through the cells of 
the organism. Martin and Cherry used a snake venom antitoxin. 
A considerable number of guinea-pigs were used. At 68° C. the 
antitoxin was destroyed, while the venom retained its virulence. In 
the control-experiment with the venom only, all the animals died 
within a few hours. A number of mixtures were made of 1 Cc. of 
antitoxin with twice the fatal dose of venom ; others with three or 
four times the fatal dose. These mixtures were allowed to stand 
at the usual laboratory temperature (20 to 23 C.) for two, five, ten, 
fifteen, and thirty minutes respectively, then heated to 68° C. and 
then injected. 

As remarked above, this heat destroyed the antitoxin, so that 
none was injected. The animals subjected to the mixture of the 
stronger doses of 10 minutes or less died, or were seriously affected ; 
all of those receiving the 15-minute mixtures survived; while the 30- 
minute mixtures produced no symptoms whatever. Similar results 
were obtained with diphtheria antitoxin and toxin. These experi- 
ments seem to show, as far as anything can, that neutralization of 
toxins may occur in the test-tube, and that the vital processes in 
the organism and the body-cells are not essential. These gen- 
tlemen made further experiments by passing a mixture of toxin 
and antitoxins through a film of gelatin in a Pasteur-Chamberlain 
filter. This was porous for toxin, but not for antitoxin, owing to 
the difference in the size of their molecules. The toxin which 



298 A TEXT-BOOK OF MATERIA MEDIC A. 

passed through the filter, after having been mixed with antitoxin, 
was neutral. The unavoidable conclusion from this experiment is 
that the toxin was neutralized before filtration. 

Further tests were made to prove their theory that toxins are 
albumoses and antitoxins globulins ; but their experiments do not 
appear to be conclusive. 

The supposition that the administration of antitoxin is followed 
by a stimulation of the germicidal powers of the body seems to 
be reasonable, at least in the case of the antistreptococcic serum, 
since the streptococci disappear with the passing away of the signs 
and symptoms. On the other hand, the Klebs-Lofrler bacillus is 
found in the throat for weeks or even months after the disappearance 
of all symptoms of diphtheria in cases treated with the antitoxin. 

Doubtless the immunizing property of serum was divined by 
those who adopted free venesection in cachectic patients, abstract- 
ing the vitiated blood and replacing it with venous injection of that 
supplied by a healthy organism. A certain antagonism had also 
been observed between infectious maladies mutually opposed in 
their development, one of which was prone to exert a curative 
action upon the other. Fehleisen in 1880 cited the phenomenal 
case of a woman afflicted with cancer of the breast, which after 
three successive operations still redeveloped rapidly. Finally ery- 
sipelas attacked the cicatricial wound of the amputated breast, the 
new malady proving beneficial to the patient, since carcinoma was 
not renewed. From this and similar data Emmerich inferred that 
it sufficed to inject the serum of animals immunized with the strep- 
tococcus of Fehleisen to treat and cure (?) cancerous subjects, the 
toxins of streptococcus erysipelatis preventing carcinomatous and 
sarcomatous development. 

Having purposely dwelt at some length upon the evolution 
and general properties of serum-therapy, let us turn to the actual 
achievement of the method in its therapeutic relations to infectious 
disease. In view of well-authenticated and obvious records attest- 
ing the efficacy of the new treatment, the charge "not proven" 
cannot properly be sustained. Yet the observation of Achalme, 
that it is well to accept new theories salts cum grano, is not inap- 
plicable ; and the wise admonition of Bacon in regard to books, 
that we should read " not to accept nor refute, but to weigh and 
consider," is equally apposite in estimating the value of scientific 
discoveries, however distinguished may be their claim to recog- 
nition. 



AL TERA TI VES. 299 

Tetanus. — The first proof that tetanus is an infectious disease, 
of bacillary origin, was furnished by Carle and Rattone, who in 
1884 reproduced the symptoms in a rabbit by inoculation of pus 
taken from a human tetanus wound. The bacilli were found in the 
adjacent soil, but it was not until 1889 that Kitasato succeeded in 
isolating pure cultures, proving conclusively the microbic nature 
of the disease. 

The earliest case treated with antitoxin was reported in 1891 
by a Bolognese physician, Dr. Gagliardi, the result being highly 
satisfactory. In the light of subsequent experiments it is of ab- 
sorbing interest. The patient, a man forty-five years of age, 
accidentally received a wound of the left foot while crossing a 
rice-field. Next day (May 12, 1891), the foot having swollen 
considerably, he consulted Dr. Gagliardi, who made an incision 
and applied antiseptics. May 19th the wound was healed, but 
four days later symptoms of trismus appeared, becoming acute 
May 24th. Injections of 5 per cent, carbolic acid in the vicinity 
of the wound produced no effect, and on June 3d opisthotonos 
and aggravated symptoms were manifested. The doctor now 
injected 0.25 c.cm. of Tizzoni's antitoxin, obtained from a strongly 
immunized dog, the treatment being followed by some im- 
provement. June 7th, relapse and tetanic spasms having super- 
vened, two more injections were administered, and the following 
day the patient gradually convalesced, being discharged as cured 
July 5th. The quantity of antitoxin sufficient to neutralize the 
tetanus-poison was less than 1 c.cm. In 1891-92 four other cases 
were treated with like favorable results, injections of 0.25 c.cm. 
twice a day, from two to six doses in all, being attended with com- 
plete recovery. When it is taken into consideration that the most 
authentic statistics of tetanus show a mortality of about 88 per 
cent., and that by the above procedure it was reduced to 20 per 
cent, it is small wonder that the issue in these cases should be 
regarded as simply marvellous. And yet we have, after devious 
wanderings, reached' but the threshold of the new science. 

In December, 1890, Behring and Kitasato demonstrated that 
the serum of animals rendered immune against tetanus by the 
injection of iodine trichloride in the blood was capable of neutral- 
izing tetanic poison, whether in the laboratory or in other animals, 
the property not being possessed by organisms not inoculated. 
Not only did they succeed in preventing infection, but they recog- 
nized in the serum a curative power, as shown in the inoculation 



300 A TEXT-BOOK OF MATERIA MEDIC A. 

and cure of mice. At the same time it was observed by Vaillard 
that the immunity conferred by the serum was of short duration, 
lasting only fifteen days. 

Kitasato's preventive injection — a mixture of living culture and 
gradually decreasing doses of iodine trichloride — was perfected by 
Behring, who successfully applied it to the mouse, rabbit, sheep, 
and horse. Various results of experimental research ensued, elicit- 
ing among other interesting phenomena the fact that removal of 
the spleen renders immunization impossible. In 1891, Vaillard 
showed that the serum of animals naturally immune is not anti- 
toxic, becoming so only after a powerful dose of tetanic poison, 
and that the spleen and the fluids of immunized subjects are devoid 
of antitoxic properties. 

One point in the doctrine advanced by Behring and Kitasato 
awakened the liveliest discussion : whether it was possible to cure 
disease by the serum of inoculated individuals. Tizzoni and Cat- 
tani had failed to attain this result, and had, moreover, recognized 
that the condition of immunity was transient. On the other hand, 
Behring had claimed the cure of tetanus in the sheep and horse, 
and Kitasato had obtained results equally positive in the case of 
mice. 

All doubt on this head was dissipated by Ehrlich in 1891, who 
proved by experiments with ricin and abrin that the antitoxic and 
immunizing property of serum varies greatly with the degree of 
immunity conferred. In seeking a favorable issue it was evident 
that in cases of failure the inoculation had fallen short of the 
degree requisite to render the serum curative. 

It should be added that in subsequent treatment Tizzoni, Cat- 
tani, and Vaillard met with perfect success in effecting cures. 

Thus far, the employment of serum as a curative agent had 
been confined to experiments upon animals. The results obtained 
urged its application to human tetanus. The first attempt was 
made by Kitasato in 1891, the serum being taken from a rabbit. 
It was unsuccessful, the dose of serum employed being too feeble 
to cope with the gravity of the conditions presented. In 1892, 
Tizzoni and Cattani and others reported 8 cures with serum from 
immunized dogs. It was contended, however, that a comparatively 
mild form of the disease was treated. In France the results of 
similar treatment in 1892 were wholly unfavorable, but in 1893 the 
cure of a peculiarly aggravated case was authentically announced, 
amelioration of symptoms having occurred in three, and complete 



AL TERA TI VES. 30 1 

restoration in twenty, days. The injection was subcutaneous in 
the abdominal region, 300 c.cm. of equine serum from an immun- 
ized animal being given. The injections are said to be in them- 
selves harmless. 

Finally, MM. Roux and Vaillard formulated the mode of prep- 
aration of antitetanic serum, together with an analysis of its prop- 
erties and its curative application in man and the lower animals. 

It may reasonably be expected that future experiments with 
the antitoxin of tetanus, made with greater precision and untiring 
patience, will produce more favorable results. 

It is of primary importance to consider, first, whether sufficient 
amounts of immunizing serum are injected to combat the condi- 
tions of this most difficult disease, and, second, whether the doses 
are renewed often enough to arrest its progress or ensure immunity. 
These desiderata are sufficiently obvious, especially in view of the 
certainty that the antitoxin is wholly innocuous. 

It is to be regretted that tetanus antitoxin does not in clinical 
use do all that it will do in the laboratory. It has been used in a 
considerable number of cases, but in nearly every instance without 
any result that would justify us regarding it as a great curative 
agent. However, it should be used early in every case of tetanus 
and in large doses, because it is, like the other serums, harmless, 
and the patient has a somewhat better chance for recovery. Not 
until our means of diagnosis have been improved by bacteriological 
methods or otherwise can we expect great results from the tetanus 
antitoxin. The following explanation for the inefficacy of this anti- 
toxin has at least the merits of some plausibility and originality on 
the part of its author. The toxin of the bacillus tetanus has a 
chemical affinity for nerve-tissue and enters into chemical combina- 
tion with and destroys such tissue; and it is this chemical combina- 
tion and destruction in the nerve-centers which produce the tetanic 
convulsions. The antitoxin has no such chemical affinity, and neu- 
tralizes only that toxin remaining in the blood-current, and, of 
course, it cannot repair the nerve-tissue lesion. When we are able 
to diagnose tetanus early the antitoxin will be used successfully. 
One or two cases have been successfully treated with intracerebral 
injections of antitoxin, the theory being that the antitoxin should 
be placed where it could neutralize the toxin which is producing 
the convulsions by means of its action on the nerve-centers. The 
value of this method of administration has not been proven. Fully 
as many cases have been treated unsuccessfully. 



302 A TEXT-BOOK OF MATERIA MEDICA. 

As a preventive measure, the tetanus antitoxin is all that can be 
desired. Dr. Joseph Hughes, one of the most eminent and conserv- 
ative veterinary surgeons in Chicago, says that he has used the 
tetanus antitoxin as a prophylactic in over five hundred cases fol- 
lowing wounds both surgical and accidental. Not one has devel- 
oped the disease, though he has used it where he was justified by 
former experience in expecting tetanus to show itself. Dr. Hughes 
uses 10 Cc. as a protective dose, and injects it five to seven days 
after the suspected inoculation. 

Diphtheria. — It is in the treatment of this universal and terrible 
disease that serum-therapy has achieved its most signal triumphs, 
the marvels wrought by its influence attracting more and more the 
attention both of the medical profession and of the laity. 

The micro-organism of the malady was described by Klebs in 
1883, his investigations being quickly followed by those of Loeffler, 
who confirmed Klebs' discovery and announced that it was possible 
not only to isolate, but also to produce, cultures of the microbe. 
Roux and Yersin, as well as other savants, have established the 
fact that the germ is found only in the false membrane — especially 
its surface — and in the saliva or contiguous mucous membrane, 
never developing in the circulating fluid either of the lymph or any 
other portion of the organism. 

The bacillus frequenting the false membrane is rarely unaccom- 
panied, but is found associated with other micro-organisms which 
exert great influence upon the progress of the disease. It propa- 
gates rapidly upon solidified serum, bouillon, and gelatin, though 
not on potato, preserving its virulence for several months. In 
direct contact with light and air it perishes within a few weeks. 

The false membrane is artificially formed by painting with pure 
culture the buccal ulcers of the mucous membrane in rabbits, dogs, 
guinea-pigs, and chickens, the symptoms produced being those of 
human diphtheria, and frequently fatal. The researches of Loeffler 
indicate that no direct action is attributable to the bacillus ; the sys- 
temic effects of the poison being rather those of a general intoxi- 
cation of unknown nature — an opinion sustained by the researches 
of Roux and Yersin. The microbe may be ejected by the mouth 
together with the false membrane, but oftener it remains in an iso- 
lated state ensconced in buccal and nasal cavities, perhaps for sev- 
eral days or even weeks. 

Although the discovery of the pathogenic micro-organism of 
diphtheria is of quite recent date, no time has been lost in seeking 



AL TERA TI VES. 303 

to determine the means of conferring immunity against the disease. 
To Behring (1889) is due the credit of having first indicated the 
method of immunization in the disease, as well as in tetanus, his 
investigations leading him to affirm that the process of conferring 
immunity by the soluble products of Loeffler's bacillus derived 
from immunized animals, combined with a solution of iodine tri- 
chloride, is positively innocuous and curative in diphtheria. 

Little progress was made by the experiments of earlier investi- 
gators, but, in 1 89 1, Aronson succeeded in immunizing rabbits 
against diphtheria by inoculation with cultures attenuated by the 
vapor of formaldehyde. The serum obtained possessed great im- 
munizing power, a single cubic centimeter sufficing to inoculate 4 
kilograms of animal weight against the minimum mortal dose of 
virulent cultures. 

Subsequently, Aronson applied this therapeutic method to 
numerous children affected with diphtheria, and affirmed with Behr- 
ing that serum-therapy was inoffensive and a sovereign remedy in 
a large number of cases. He obtained the serum from dogs and 
sheep, but declared that large animals were preferable, especially 
the horse. 

In order to formulate the dosage, Behring established a techni- 
cal scale in which one cubic centimeter of prepared serum is consid- 
ered a unit, the antitoxin supplied being of the strength of 60, 150, 
or 500 units according to the degree of immunity of the animal 
from which it is derived. The value of serum depends, he affirms, 
upon the difference between the original condition of, and the re- 
fractory state attained by, the animal under immunization. 

Notwithstanding the significance attaching to experiments hith- 
erto recorded, the thereapeutic application of serum-therapy to 
diphtheria may be said to date from the communication of Roux 
to the Congress of Buda-Pesth (September, 1894). From this 
moment clinical observations multiplied and statistics were reported 
from all parts of the world. 

In this memorable address the author ably reviewed the entire 
subject of serum-therapy, stating the relations of serum to the 
general economy and offering advanced and cogent suggestions 
concerning the employment of antitoxins to arrest the ravages of 
infectious disease. The early failures to cure tetanus were explained 
by the fact that the symptoms of the disease are frequently not 
manifested until it is too late to stay its progress. On the other 
hand, in diphtheria the evident appearance of the characteristic 



304 A TEXT-BOOK OF MATERIA MEDICA. 

false membrane rendered it possible to treat the malady from its 
inception. The most approved, though complicated, methods of 
preparing the toxin were minutely described — either through the 
medium of bouillon as a host in contact with dry air, or a similar 
process in a current of moist air — and explicit instructions given 
regarding the attenuation of the poison by means of iodine, and the 
modus operandi of administration in gradually intensified doses. 

At an international Congress held in Munich in April, 1895, 
the merits of serum-therapy in diphtheria formed the subject of 
an interesting debate, eliciting reports from the most competent 
Continental authorities in which the efficacy of the new treatment 
was strikingly demonstrated. d 

Dr. O. Heubner of the University of Berlin, comparing the 
statistics of the Berlin hospitals during 1894, stated that the mor- 
tality since the introduction of serum-therapy had been reduced to 
one-half of that recorded prior to that date, about 1500 cases being 
included in each period. Allowing for the condition of medium 
virulence which marked the disease, Prof. Heubner believed that 
this factor alone could not account for the great difference in the 
mortality. Up to the present time, he said, reliable information of 
over 3000 cases had been obtained from all parts of the world in 
which the disease was treated with antitoxin serum. The average 
of cures was 80 per cent. Referring to clinical analysis of 300 
cases of diphtheria coming under his own supervision, he declared 
that the disease could be diagnosed only by identification of the 
diphtheria bacilli. Of 207 cases so diagnosed and treated in the 
Berlin Charite, the mortality in simple attacks was 10 per cent., 
and in more complicated ones 13 per cent. From personal expe- 
rience the speaker regarded, as the specific results of serum-treat- 
ment, the improvement in the febrile symptoms and the quickened 
cleansing of the air-passages — facts first noted since the introduc- 
tion of serum-therapy, and confirmed wherever the method was 
adopted. 

Prof. A. Baginsky of Berlin said that prior to the introduction 
of the treatment with serum the more difficult and sorrowful por- 
tion of his life had been spent in combating the disease, against 
which he felt absolutely helpless, the mortality for the past four 
years, in spite of every effort, having been 50, 33, 36, and 42 per 
cent, respectively. The deaths occurring under treatment of 525 
cases with Dr. Aronson's preparation had been 1 5 per cent. 

Prof, von Widerhofer of Vienna stated that in 300 cases of 
diphtheria coming under his observation the average mortality was 



ALTERATIVES. 



305 



23.7 per cent. Excluding those that died within twenty-four hours, 
the disease having reached a very advanced stage previous to 
treatment, the mortality falls to 14.3 per cent. 

Prof, von Ranke of Munich reported that of 124 cases treated 
in the six months previous, 26 children, or 22.4 per cent., died, 102 
cases presenting features of uncomplicated diphtheria. Compared 
with the mortality during the preceding eight years, the reduction 
was enormous, being less than half the minimum record for any 
year during that period. 

Prof, von Mehring reported on 74 cases, all treated with serum 
on the first or second day, of which only 4 died, giving a mortality 
of 5 per cent. During the preceding five years 30 per cent, of his 
diphtheria patients had died. 

Prof, von Noorden gave the results of his experience in 81 cases 
treated at the Frankfort Hospital. Most of them, unfortunately, 
were admitted at a late stage of the disease, generally on the third 
or fourth day, the severest symptoms being developed. Notwith- 
standing this obstacle, in place of the previous mortality of 45 per 
cent., only 23 per cent, was recorded. 



Authorities. 



Vierordt .....' 

Ganghofner 

Viederhofer ........ 

Kossel . ... ..... 

Baginsky (quoted by Virchow) 

Sonnenburg , 

Aronson 

Ranke = . . . , 

Soltmann 

Risel 

Roux, Martin, and Chaillou . , 

Lebreton 

Moizard 

Washboutn, Goodall, Card, a 

others 

White 

Withington 

Total number of cases 

Average mortality, per cent 

Previous average mortality, per cent 

Collective report of other observers in different 

countries 



Locality. 



Heidelberg 
Prague 

Vienna . 

Berlin . . 

Berlin . . 

Berlin . . 

Berlin . . 

Munich . 

Leipsic . 

Halle . . 

Paris . . 

Paris . . 

Paris . . 



London . 
New York 
Boston 



Cases 

treated with 

serum. 



55 
no 
100 
35o 
303 
107 
190 

85 
122 
114 
300 

258 
231 

195 
32 
80 



2632 



4022 



Mortality 
in percent. 



I4.6 
12.7 

25-3 
16.7 
13.2 
20.6 
14.0 
18.8 
18.0 
8.0 
26.0 
12.0 
14.7 

18.6 
25.0 
16.0 



16.8 



[7.1 



Previous 

mortality 

in per cent. 



58.0 
50.O 
42.8 

34-7 
47.8 
27.6 
37.o 

48.5 



51-7 
50.0 

3ii 

42.7 

45-o 



42.0 



Dr. G. Seiz of Constance stated that of 27 cases treated with 
serum he lost only 1, or 3.3 per cent. 



20 



l 



306 A TEXT-BOOK OF MATERIA MEDICA. 

Prof. Sigel, in charge of the Olga Hospital at Stuttgart, reported 
that the general mortality for the five years previous to 1 894 was 
40.1 per cent., and 60 per cent, among those upon whom trache- 
otomy was performed in the first nine months of 1894 — in fact, up 
to the day on which the antitoxin treatment was commenced — the 
mortality rising to 50.3 and 70 per cent, respectively. During the 
three months of serum treatment in 1894 there was an astonishing 
decrease in the number of deaths, the mortality falling to 12 per 
cent, in general and 20.3 per cent, in tracheotomy cases. 

The reports, emanating from authorities of the highest standing, 
were of themselves conclusive testimony in favor of serum-therapy 
in diphtheria as immensely superior to former methods of treatment. 

An interesting resume of statistics, compiled from the library 
of the Royal College of Surgeons, England, by Dr. G. C. Crandall 
of St. Louis, Mo., emphasizes in comprehensive figures the explicit 
advance made within a few years in the scientific control of the dis- 
ease. The table on page 296 embodies the results of Dr. Cran- 
dall's timely study of the subject. 

The official report from the Imperial German Health Depart- 
ment up to June 20, 1895, records 2228 cases, with a percentage 
of mortality of 17.3; and further German statistics (August 10, 
1895) include 10,240 cases in hospitals and private practice, 5790 
of which were treated with antitoxin serum, the number of deaths 
being 552 — a mortality of 9.5 per cent. 

Prof. Eulenburg, the author of this report, reiterated the import- 
ance of early recourse to antitoxin, stating that when used within 
the first forty-eight hours the mortality was only 4.2 per cent. : 
delayed beyond this period, the percentage was increased to 16.8, 

In America the merits of serum-therapy have been amply 
attested by reports from various sections of the country, one of 
the most recent and instructive being that of the resident physician 
of the South Department of the Boston City Hospital, as follows : 

"In the Boston City Hospital, from Feb. 1, 1894, to Jan. 31, 
1895, before antitoxin was used, 698 cases of diphtheria were 
treated, with 266 deaths — a mortality of 38.1 per cent. Since the 
opening of the South Department, from Sept. 1 to Nov. 30, 1895, 
inclusive, when antitoxin was used in every case, 332 cases were 
treated, with 41 deaths — a percentage of 12.3. Of these 41 deaths, 
23 occurred within twenty-four hours of entrance. Eliminating 
these, there were 309 cases with 18 deaths — a mortality of 5.8 per 
cent." 



AL TERA TI VES. 307 

Finally, the statement of Prof. Welch of Johns Hopkins Uni- 
versity, published in July and August, 1895, contains statistics of 
7166 cases of diphtheria treated with antitoxin, in which the mor- 
tality was 17.0 per cent., and 2276 cases treated otherwise with a 
death-rate of 42 per cent. 

The foregoing figures, selected from a mass of corroborative 
testimony, must certainly be regarded as an eloquent tribute to the 
virtues of serum-therapy. They are at least a striking illustration 
of what Virchow has called the " brute force " of the numerical 
argument. 

Touching the method of administration and collateral manifes- 
tations, Roux, in the communication previously cited, says : 

" The serum I have employed, derived from immunized horses, 
had an active strength of 50,000 to 100,000. To all diphtheritic 
patients entering the hospital 20 cubic centimeters of this serum, 
in a single dose, are systematically administered, the injection being 
in the subcutaneous tissue, and not renewed should bacteriological 
examination prove that the disease was other than diphtheria. 
Should the existence of the disease be fully established, I have 
never observed the slightest discomfort resulting from the dose. 

" The injection is painless, and if made antiseptically should be 
attended with no accident. Twenty-four hours after the first injec- 
tion a second is made of 10 or 20 cubic centimeters, these two 
inoculations sufficing, as a rule, to ensure recovery. 

" Should the temperature continue high, a third injection of 
10 or 20 cubic centimeters is given. The average weight of chil- 
dren being 14 kilograms, the total dose constitutes one-thou- 
sandth, or in exceptional cases one-hundredth, part of their weight. 
Untoward sequelae are less frequent under the use of serum, 
although I have observed symptoms of paralysis. Eruptions, also, 
allied to urticaria may be occasioned by the antitoxin. 

" The physiological effect of the serum is apparent in its action 
upon the false membrane, which ceases to develop within twenty- 
four hours after the first injection, being detached after twenty-six, 
forty-eight, or, at most, sixty hours. In 7 cases only have I known 
it to persist longer. Let me add, in conclusion, that in treatment 
with serum I have studiously avoided the use of local applications, 
simply irrigating the throat with boiled water, to which was added 
perhaps 50 grams (per liter) of Labarraque's solution." 

In commenting upon the address of M. Roux, Dr. Behring 
added that "the specific action of antidiphtheritic serum is the 



308 A TEXT-BOOK OF MA TERIA MEDICA. 

surer and more rapid in proportion to the heroic nature of the dose. 
Since the injection is positively harmless, it may be adopted with 
impunity even in simply suspected cases of the disease." 

The prophylactic property of equine serum is well attested by 
Aronson, who employed antidiphtheritic injections to immunize 
children in families where the disease was established. One cubic 
centimeter of prepared serum sufficed for his purpose, of 130 chil- 
dren thus treated preventively only 2 being affected with a very 
mild form of the disease. 

It is impossible, says Bernheim, to assign a definite duration 
to the antitoxic property of serum. It may last several weeks, or 
even months, according to the strength of the injection and the 
species of animal under treatment. But, he adds, when definite 
immunity has been attained the protective power of serum may be 
prolonged by the injection of a small quantity of toxin every 
fourteen days. 

Concerning the various untoward complications arising from the 
use of serum and authentically reported, it is fair to say that the 
same phenomena are observed in diphtheritic patients treated by 
other methods than serum-therapy. 

Notwithstanding the eminent success of the method herein con- 
sidered, it should be said, in conclusion, that several important 
features are as yet but imperfectly formulated or even understood. 
It is of paramount interest to ascertain, for example, the precise 
prophylactic power of the immunizing serum. Behring has already 
directed his attention to this problem, advising the injection of 5 
cubic centimeters of serum in children under ten years of age, and 
10 cubic centimeters in older patients. Crouzon, who has prac- 
tised these preventive injections in 230 cases, reports but two light 
attacks of the disease. A similar experience is that of Baginsky 
in Berlin. Bernheim asserts that he has personally injected serum 
in 28 subjects exposed to diphtheritic infection without noting a 
single case of the malady. The dose employed was somewhat in 
excess of that proposed by Behring, being from 10 to 20 cubic 
centimeters, as recommended by Hilbert, the injection being twice 
repeated at intervals of twenty days. 

From a careful consideration of the subject in its relations to 
diphtheria, we may safely conclude — 

1st. That immunized serum forms a remedy which experience 
proves to be wholly innocuous and eminently adapted for use in 
human infection. 



ALTERATIVES. 309 

2d. That antidiphtheritic serum has in every respect corre- 
sponded with the most sanguine hopes of its advocates, its employ- 
ment being attended with astonishing success wherever properly 
used and in sufficient quantities. 

3d. Finally, that it is incontrovertibly established that by means 
of injecting serum temporary immunity from infection may be 
readily conferred, permanent protection being contingent merely 
upon a renewal of treatment. 

The present status of diphtheria antitoxin may be presented in 
a few words. It has established itself as a specific in the treatment 
of this disease. During the past year the use of larger doses has 
become more general, and it seems certain that better results are 
obtained. The administrators of the Chicago Department of 
Health give 2000 units in all cases of suspected diphtheria, and 
employ 1000 units as an immunizing dose. During the months of 
November and December this department treated 219 cases of 
bacteriologically proven diphtheria, all charity cases, with a death- 
rate of 4.1 per cent. Some two and a half years ago, when anti- 
toxin was not used, the death-rate from diphtheria treated by this 
department was about 35 per cent. 

Tuberculosis. — It may be stated, in general terms, that the 
microbic nature of tuberculosis was admitted by nearly all writers 
upon the subject before the discovery of the pathogenic micro- 
organism. Villemin in 1866 had established by experiment the 
infectious character of the malady ; but in France the idea seemed 
almost revolutionary, creating no enthusiasm, it being reserved for 
Germany, through the indefatigable labors of Robert Koch, to 
develop and elucidate the theory conceived by Villemin. Koch 
discovered the bacillus of tuberculosis, and even succeeded in iso- 
lating and cultivating it, the pure cultures obtained by him always 
producing tuberculosis in every form. His original communication, 
addressed to the Physiological Society of Berlin, bore date of 
April 10, 1882, and at once stimulated experimental research in 
others, who fully confirmed his discovery. 

The tubercle bacillus is aerobic and facultative anaerobic, a 
fact readily explaining its predilection for pulmonary tissue. The 
bacillus may effect all warm-blooded animals, although in different 
degrees, the microbe being somewhat differentiated in the lesions 
of birds and those of man and the mammalia in general. 

Spontaneous tuberculosis is extremely frequent in man, it being 
estimated that one-fifth of all fatalities are due to phthisis in its 



310 A TEXT-BOOK OF MATERIA MEDICA. 

various forms. It is also common among cattle, in which the 
progress of the disease and its lesions are markedly similar to those 
observed in human beings — a fact demonstrated by the admirable 
studies of Koch respecting pulmonary lesions and their character- 
istic pathogenic micro-organisms. 

Like other microbes, the bacillus tuberculosis produces a large 
amount of soluble products. These toxins, which of late years 
have been subjected to careful experiment, are derived from cul- 
tures of human bacilli, modified or not by aviary germs and the 
tuberculous products produced in the organism itself. Koch's 
tuberculin, now known throughout the world, is simply a soluble 
product, prepared by a special process, consisting of a glycerized 
extract drawn from pure cultures of tubercle bacillus, its activity 
depending upon the virulence of the germs, those derived from 
man being more dangerous than aviary cultures. 

Various methods of inoculation have been adopted in tubercu- 
losis : i, inoculating the patient with another disease; 2, inocula- 
tion with attenuated tuberculosis or that proceeding from a different 
species, as from birds ; 3, inoculation of the soluble bacillar prod- 
ucts — tuberculin; 4, injection of blood taken from animals often 
immune against tuberculosis; 5, injection of serum drawn from 
inoculated animals ; 6, finally, injection of serum taken from 
immunized animals. With the last two of these methods we are 
properly concerned. The fifth has been scientifically adopted by 
Babes, Richard, and Hericourt, who have treated a large number 
of cases in which various cures have been effected. The main 
obstacle of the procedure lies in the difficulty of successful inocu- 
lation, the greater part of the animals employed dying of infectious 
nephritis. 

By the sixth method, as employed by Bernheim, this fatality is 
largely obviated, a careful procedure with the serum of immunized 
animals proving the most efficacious hitherto devised. The pro- 
cess of immunizing consists in injecting the toxic products nor- 
mally secreted by Koch's bacillus, and is, in effect, that adopted by 
Behring in preparing the antitoxin of diphtheria. In experiment- 
ing upon a large number of animals, suffice it to say that the 
results obtained by Bernheim were eminently satisfactory, every 
case indicating improvement and the actual cures being about 40 
per cent. So convinced was he of the sovereign value of his 
method that he emphatically declared it to be the only rational 
procedure possible in tuberculosis. 



AL TERA TI VES. 3 1 1 

The discovery by Koch of the bacillus tuberculosis revolution- 
ized the generally accepted theory of tubercular disease, and with 
his further announced discovery of the antitoxin of the germ great 
expectations were raised touching the possibility of conquering the 
dread malady. It soon developed, however, that Koch's claim was 
premature, and although able and diligent workers have labored 
constantly to attain the desired end, it must be admitted that thus 
far they have met with doubtful success. In 1888 Hericourt and 
Richel succeeded in transferring immunity to tuberculosis from 
dogs to rabbits by means of serum injections. For several years 
Drs. E. L. Trudeau and E. R. Baldwin have carried on a series of 
interesting experiments designed to secure immunity from the dis- 
ease. The results are as follows : 

1. A sheep was injected intravenously with killed thymus cult- 
ures. The result was so unsatisfactory that the serum-tests were 
not conclusive. 

2. Chickens were inoculated intraperitoneally with mammalian 
tuberculosis. The serum revealed no germicidal nor inhibitive 
action on the tubercle bacilli, nor favorable influence on the course 
of the disease in guinea-pigs. 

3. A sheep was injected with tuberculin. The serum was want- 
ing in germicidal, antitoxic, or curative effect, so far as tested. 

4. A sheep was inoculated intravenously with non-virulent cult- 
ures. Cachexia followed, and the serum was therefore not used. 

5. An ass was inoculated as in 4 ; it died from pulmonary embo- 
lism. The serum was not bactericidal to tubercle bacilli. 

6. An ass was inoculated with virulent tubercle bacilli and treated 
with tuberculin. The serum showed no germicidal nor curative, 
but possibly some antitoxic, effect. 

7. An ass was inoculated with non-virulent tubercle bacilli and 
treated with various extracts of tubercle bacilli and dead bacilli. 
The serum showed no activity. 

8. Rabbits were inoculated with non-virulent and virulent tuber- 
cle bacilli, and recovered. Their serum possibly conferred some 
protection in tuberculin-poisoning, and possibly prolonged the lives 
of treated guinea-pigs. 

It is especially noteworthy that in the above experiments the 
serums were powerless to prevent local or general reaction from 
small doses of tuberculin, nor to influence the temperature in tuber- 
culous animals. On the whole, the outlook may be regarded as 
far from encouraging in our present knowledge of antitoxins. It 



312 A TEXT-BOOK OF MATERIA MEDICA. 

is impossible to conjecture, however, what future investigations 
may reveal. 

The anti-tubercle serum has not proved itself of more value 
than a great number of other remedies vaunted as a specific in this 
disease. Maragliano of Italy continues to send encouraging re- 
ports, and has recently erected a tuberculosis hospital in or near 
Rome, where his antitoxin is to be used. It must be confessed, 
though regretfully, that this serum has not been a marked success 
in this country. 

Pneumonia. — Fibrinous, croupous, or lobar pneumonia is an 
acute infectious form of the disease, usually occasioned by the 
diplococcus pneumoniae, and affecting an entire lobe, or perhaps 
more, of one or both lungs. 

The diplococcus pneumoniae (Frankel-Weichselbaun) most fre- 
quently occurs in the sputa and lungs, and appears to be unques- 
tionably the cause of the malady, although occasionally other 
micro-organisms seem to cause typical fibrinous pneumonia, as, for 
instance, the pneumococcus of Friedlander, streptococcus, staphy- 
lococcus, typhoid bacillus, the bacillus of influenza, and the bacillus 
coli communis. In fact, a number of various germs may cause the 
disease, the result of mixed infection. The fibrinous form of pneu- 
monia occurring in tuberculosis is without doubt a secondary infec- 
tion, as is the case in typhoid fever and influenza, the particular 
bacilli of which may cause pneumonia. 

The germs above mentioned usually reach the lungs through 
the bronchi, the diplococcus pneumoniae being frequently found in 
the mouth and upper respiratory passages, indicating one source 
of infection. In rare instances the germs may be inhaled, or may 
gain access to the lungs through the circulation. 

The pneumococcus does not confine its attacks to man, the 
rabbit and guinea-pig being especially sensitive to its influence. It 
has been observed that the microbe is a frequent prey to leucocy- 
tosis. It thrives in a total absence of oxygen, its vitality and viru- 
lence, so far from diminishing, being sensibly increased by anae- 
robic conditions. Pure cultures are easily obtainable. 

Repeated inoculations of attenuated virus readily confer immun- 
ity, reduction of virulent germs being attained by the use of desiccated 
pneumonic viscera. The saliva of a patient, collected after defer- 
vescence, ensures protection to the mouse, the same being true of 
blood-serum. Immunization of animals was inaugurated by Em- 
merich and Fovitsky in 1891, subsequent investigators confirming 
their experiments under varying conditions, Foa and Scabia finally 



AL TERA TI VES. 3 1 3 

employing human serum in the inoculation of rabbits with marked 
success. 

It had been supposed that the spleen was the seat of an im- 
munizing product possessing greater activity, but a glycerized 
extract of human spleen injected into the veins of refractory rabbits 
failed to arrest death. The general deduction drawn from a care- 
ful scrutiny of the subject tends to prove that the production of 
the neutralizing force in the system — the antipneumotoxin — is 
shared by all the elements of the organism, including the spleen. 

The therapeutic interest of the subject centers in the application 
of inoculation to man. The early experiments of Foa and Scabia 
were without result, neither reaction nor amelioration attending 
their treatment; but in 1892, Klemperer reported favorably con- 
cerning immunization in 40 cases of human pneumonia. 

In January, 1893, Lava communicated to the Academy of Med- 
icine in Turin the application of serum-therapy with auspicious 
results. He inoculated 10 subjects — 5 with from 4 to 9 cubic cen- 
timeters of rabbit's blood-serum ; 4 with a like dose of glycerized 
extract of the viscera of immunized rabbits ; and 1 with from 4 to 
5 cubic centimeters of canine serum. There is no reaction at the 
point of inoculation, no general disturbance of the system, nor 
any influence upon temperature or respiration. On the contrary, 
the pulse is favorably influenced, as is also the general progress, as 
shown by Lava's experiments. Moreover, the injection hastens 
the crisis of the disease, conducing rapidly to complete restoration. 

Rozzolo also reported 5 cases treated with serum, 4 of which 
were cured. No influence upon the pulse, heart, or kidneys was 
noted. 

The effect of animal serum is fugacious ; that of the human 
product lasts several days. In all cases the serum of immunized 
subjects possesses a therapeutic but not an antitoxic power. It 
does not diminish the virulence of pneumococci, which, injected in 
an inoculated organism, retain their pathogenic activity about 
eighteen hours, after which, indeed, their vitality is manifested by 
the production of toxins producing positive chemotaxis in the 
phagocytes. 

Among other curative methods in pneumonia may be cited the 
hypodermic injection of blood taken from convalescents and the 
infusion of blood from similar patients. The former resulted fav- 
orably (Audeoud), and the latter (Hughes of Philadelphia), an 
intravenous operation, was no less successful. 



3^4 A TEXT-BOOK OF MATERIA MEDICA. 

Audeoud explains the natural crisis in pneumonia by the theory 
of Klemperer — that the antipneumotoxin formed in the blood of 
an inoculated subject by neutralizing the pneumotoxin cures the 
infection. 

Cholera. — The microbe of this terrible disease had been sought 
since 1848, yet the subject had never been profoundly studied until 
Koch succeeded in isolating the germ. Being associated with 
other micro-organisms, the bacillus had remained undetected, being 
distinguishable, in fact, only in fulminant attacks of the disease, as 
was noted by Strauss and Roux. 

Stagnant water is particularly favorable to the propagation of 
germs. In distilled water the bacillus survives but twelve hours ; 
in drinking-water, seven days (Babes) ; while in river or well-water 
it may live for seven months (Wolfhugel). As a rule, the acids are 
injurious to the bacilli, bichloride of mercury, sulphate of copper, 
and quinine being very powerful antiseptics in presence of the 
germs. 

Cholera has been observed in man alone, though Koch imparted 
the disease to guinea-pigs, to which it was fatal. One physician in 
Weichselbaum's laboratory contracted the disease from cultures. 
The pathogenic power of the bacillus is well demonstrated by the 
fact that in one of the Berlin hospitals, of 207 patients attacked by 
cholera nostras (cholerine) in which no germ was manifest, but one 
case proved fatal ; and, notwithstanding vigorous opposition, Koch's 
original thesis appears to be sustained by observation. 

A singular fact in connection with cholera germs is that they 
may be ingested at times, if not with impunity, at least without in- 
ducing the disease. Pettenkofer, having taken large doses of alkali, 
absorbed a considerable quantity of the poison with only the effect 
of a diarrhea during five days, there being no disturbance of the 
general system or of the kidneys. Emmerich, ingesting the tenth 
part of Pettenkofer's dose, was seized with diarrhea twenty-four 
hours afterward, and became seriously ill. Purging lasted four 
days, and on the eleventh day the bacilli disappeared from the 
stools. 

It were beside the purpose of the present work to relate in 
detail the many interesting experiments upon animals undertaken 
with a view to the application of serum-therapy in the treatment of 
human cholera. Although the experimental investigations of 
recent years foreshadow the possibility of immunization in man, it 
must be confessed that, as in the case of tuberculosis, they have 
been thus far barren of definite results. It is announced that Behr- 



AL TERA TIVES. 3 1 5 

ing has discovered a practical method of combating the disease : 
until the results of his later researches are known the therapeutic 
problem must apparently remain unsolved. The results of Haff- 
kin's investigation in India were awaited with interest, but they 
have not proved satisfactory. 

Septicemia. — The streptococcus of Fehleisen (erysipelatis), 
which causes erysipelas, was discovered by Nepveu in France and 
Hiiter in Germany (1868-80), and has been the subject of careful 
study by Klemperer and others in the hope of determining its 
availability as an immunizing agent. Employing the serum of 
immunized rabbits, it has been found possible by intravenous injec- 
tion to cure the disease in mice, the serum proving efficacious only 
against the disease with which the animal supplying it was inocu- 
lated. Subsequent experiments have been attended with varying 
results, Marmorek in February, 1895, having succeeded in obtain- 
ing a germ of streptococcus so virulent that the hypodermic injec- 
tion of 1 ^q Q of a cubic centimeter was fatal to the rabbit in thirty 
hours. Inoculation with this microbe or its toxins conferred im- 
munity upon rabbits, which furnished a preventive and curative 
serum. 

Encouraged by previous experimentation, Charrin and Roget 
now sought to apply the method of serum-therapy in the treat- 
ment of puerperal fever. Having satisfied themselves of the cura- 
tive property of the serum of a mule inoculated with the microbe 
of erysipelas, collected fifteen days after the eighth inoculation, 
they injected subcutaneously 8 cubic centimeters of serum in a 
woman affected with the fever. The report is as follows : " The 
next day no improvement. A second injection of 8 cubic centi- 
meters. Next day condition slightly improved, but still serious. 
Third injection of 25 cubic centimeters. Result on the following 
day rapid improvement ; decline of fever ; general good health ; 
and early establishment of convalescence." 

Anti-streptococcic serurn gives promise of being second only to 
the diphtheria antitoxin in point of therapeutic value. It has been 
most successful in erysipelas and puerperal septicemia. Cases of 
scarlet fever are reported where it has been useful in shortening the 
duration of the disease and in preventing unfortunate complications 
and sequelae, such as otitis media and other suppurative processes 
due to streptococci. 

The latest reports on anti-streptococcic serum are not so encour- 
aging as the earlier ones. 



316 A TEXT-BOOK OF MATERIA MEDICA. 

Syphilis. — The pathogenic source of syphilis is still unknown. 
The disease being contagious, attempts have long been made to 
discover its specific microbe, yet the highest authorities agree that as 
yet all researches have proved abortive. No lower animal is known 
to be susceptible to the malady, and, although various experiments 
have seemed to prove the contrary, it is now determined that the 
lesions primarily indicating contraction of syphilis were the result 
of septicemia induced by some agent infected with the syphilitic 
virus. 

The sero-therapeutic methods employed in the treatment of the 
disease consist of inoculation with the blood of naturally immune 
or of syphilitic subjects. Of all animals, the horse is perhaps the 
only one capable of syphilization. 

Tommasoli in 1892-93 essayed inoculation of public women, 
affected with acute secondary syphilis, with lamb's serum, the 
results being, according to his report, highly favorable — even to 
the cure of syphilitic infection. Many untoward symptoms, how- 
ever, have attended the inoculations thus made. Mozza (1893) 
instituted a series of experiments, employing blood from the carotid 
artery of a lamb or dog, and another series in which injections were 
made of serum drawn from sheep inoculated with serum from 
syphilitic subjects in whom the disease was latent. His records 
indicate no very satisfactory results, yet he demonstrated that 
aseptic precautions allow the application of serum-therapy without 
local or general reaction. 

Finally, Hericourt and Richet attempted, with dubious success, 
the experimental injection of syphilitic serum, the results, in their 
therapeutic importance, being inconsequential. 

Typhoid Fever. — The bacillus of this disease was first detected 
in the kidneys by Bouchard in 1879. The name was given by 
Eberth, who studied the germ in 1880-81. Old cultures contain 
an exceedingly toxic ptomaine, besides a soluble substance capable 
of inoculating animals. The vigor of the bacillus of Eberth is re- 
markable, Grancher and Deschamps having shown that it sur- 
vives five and a half months at a depth of 50 centimeters in damp 
soil. Infection may occur through the medium of the pulmonary 
tract, and the microbe is transmissible from the mother to the 
fetus. 

All animals yet submitted to experiment are naturally immune, 
the first effort to inoculate them dating from 1862 (Murchison) ; 
the attempt proved futile. Other experiments in this direction 



ALTERATIVES. 317 

were attended with like failure until Vidal and Chantemesse suc- 
ceeded in inoculating with very virulent cultures 30 white mice, 17 
of which succumbed within twenty-four hours. 

Later experiments have proved the extreme virulence of serum 
derived from a typhoid human subject, fatality speedily resulting 
from its injection, caused not by the microbe itself, since none are 
found after death, but by its toxic products. 

Among the phenomena observed in varied experimentation the 
inexplicable fact was revealed that the serum of certain persons 
never having contracted typhoid fever conferred immunity upon 
guinea-pigs. 

Casual experiments followed without favorable progress, other 
than the reduction of temperature. In January, 1895, however, 
M. Legrain, turning his attention to typhus — so closely allied to 
true typhoid fever — met with encouraging success. Injecting suc- 
cessively increased doses of serum from typhus convalescents, 
besides the reduction of temperature within three hours after the 
operation it was noted that stupor, coma, and even hemiplegia of 
a toxic nature, disappeared after an injection of 10 cubic centimeters. 
In a case of grave typhus the injection of 14 cubic centimeters on 
the fourth day of the infection resulted in lowering the temperature 
and inaugurating recovery within two days. In other serious cases, 
where the injection was delayed until the sixth or eighth day of 
the infection's course, the disease, though not arrested, was marked 
by mitigated symptoms. The serum of convalescents was taken 
after one week's remission of febrile manifestations. 

Relying upon the fact that an attack of typhus confers immunity 
against a second access of the disease, Stern sought to ascertain 
whether the serum of individuals cured was endowed with immu- 
nizing properties. The results were partially successful, eliciting 
the curious fact that the protective power of the serum appeared 
most active in those who finally succumbed to the disease. It also 
seemed problematical, to judge from these and other instances, 
whether immunized serum employed in this disease possesses either 
bactericidal or antitoxic properties. 

Recent investigations in the English army in India have shown 
the great value of typhoid immunization. The results in many 
cases have been remarkable. 

Influenza. — Although the disease has occurred at intervals since 
the serious epidemic of 1830-33, the earliest microbiological studies 
of influenza date from the epidemic of 1889-90. Investigation at 



318 A TEXT-BOOK OF MATERIA MEDICA. 

that time revealed no microbes in the sputum and viscera, save 
those which habitually frequent the bucco-pharyngeal cavity — 
streptococcus, pneumococcus, pneumo-bacillus, and staphylococcus 
— which diversity of germs might induce the belief that "la grippe" 
is not due to any single micro-organism, but to several. 

Notwithstanding this and similar suppositions, the majority of 
microbiologists maintain that these bacteria are but the result of a 
secondary infection, and that the true germ of influenza is still 
unknown, although many investigators have thought they had iso- 
lated the specific microbe. 

One deduction is constant as the result of their studies : the 
great importance of secondary infections in the course of the 
disease. 

Failure to discover the germ was in reality due to a deficiency 
of technique — inadequate methods of staining. Pfeiffer devised a 
new method, by which he detected it, and Kitasato (1892) suc- 
ceeded in isolating and cultivating the identical microbe. 

Animals do not contract the disease spontaneously, although 
the saliva of cats and dogs contains a bacillus having a pathogenic 
influence upon rabbits, the character of which closely resembles 
that of the Pfeiffer bacillus. Monkeys and rabbits contract the 
malady when inoculated with the pure culture of this germ. 

In man the port of entry, so to speak, of this microbe is the 
pulmonary tract, where it often produces lesions of suppurating 
broncho-pneumonia. The general phenomena observed in the 
disease are held by Pfeiffer to be the result of intoxication, the 
microbes being localized ; Cauch, on the contrary, considers them 
due to the presence of the microbe in all the organs, even the 
blood. The latest investigations confirm the opinion of Pfeiffer. 

Brischettini has demonstrated that the propagation of the Pfeiffer 
bacillus is not checked by the action of serum from immunized 
animals, being limited to diminishing the toxicity of its soluble 
products. The immunity caused by the injection of these products 
is augmented by the injection of the culture. 

The injection of serum of an immunized animal neutralizes 
in vitro the toxins secreted by the bacillus, and in a healthy organ- 
ism establishes immunity, whether against infection or intoxication. 
It is therefore assured that in future use the serum may be em- 
ployed at once as an inoculative and curative agent. 

Reptile Poisons. — It has long been known that certain animals 
(reptiles) possess natural immunity against their own venom. The 



AL TERA TI VES. 3 1 9 

poison of the toad having been detected in his blood, the reptile's 
immunity was at first thought to be due to tolerance, the same 
condition existing in the salamander and viper. 

The relation between the blood and the venomous glands demon- 
strates the internal secretion of these glands. The idea of an anal- 
ogy between microbic virus and reptilian venom was deduced from 
the existence of soluble microbic toxins, as elucidated by Chauveau. 
The attenuating power of heat upon the venom of serpents has 
also its analogue in the similar susceptibility of micro-organisms. 
A mortal dose of venom subjected for five minutes to a heat of 
ioo° C. may be injected with impunity into a guinea-pig weighing 
500 grammes. 

The reaction of the organism engenders an antitoxin which, in- 
jected into a healthy animal, is preventive of fatal inoculation. The 
precise nature of this antitoxin is undetermined, yet its protective 
power is evident. Certain it is that the serum of a rabbit inocu- 
lated against viperous venom, when injected an hour and a half 
before the poison, completely neutralizes the latter. Curiously 
enough, this preventive serum of rabbits inoculated against the 
poison of vipers also confers immunity against cobra-venom. 

So far as affects man, Calmette announces that he has employed 
serum with success in the treatment of snake-bites, even to the 
extent of curing them. 

Calmett's anti-venin has now become perfected and is found a 
reliable mode of treating cobra-poisoning. 

Carbuncle (Anthrax). — The bacterium of anthrax, of the genus 
bacillus, has proved a subject of elaborate and interesting experi- 
ment, many features of which are of absorbing interest alike to the 
bacteriologist and the clinician. The animals subjected to inocula- 
tion have been chosen with great care, and those supplying the 
immunizing serum include many species. The general results of 
protective inoculation have been treated briefly early in the discus- 
sion of serum-therapy. 

Rabies. — In January, 1881, Galtier announced that intravenous 
inoculation of rabid saliva confers immunity upon sheep, confirm- 
ing his experiments later in the year by injecting the fluid into nine 
sheep and one goat. Pasteur, Chamberland, Roux, and Thuiller 
pursued experiments in a similar line, with somewhat negative 
results. 

By passing the virus successively from dogs to monkeys Pasteur 
was able to attenuate its virulence, and finally, by transferring the 



320 A TEXT-BOOK OF MA TERIA MEDICA. 

poison from monkeys to rabbits, a serviceable immunizing agent 
was obtained, still further experiments perfecting the method in 
view. 

Satisfied with his success, Pasteur now turned his attention to 
the inoculation of man against hydrophobia. The first operation 
(in 1885) was attended with auspicious results, and from that 
moment the savant's laboratory was invaded by affected individuals 
demanding cure. Institutes were founded in various parts of the 
world, that in Paris being the center of bacteriological study in 
France. In America the subject has received wide attention, but 
in many instances the benefits derived from Pasteur's inoculative 
procedure have been held to be of doubtful importance by intelli- 
gent observers. 

Pasteur's treatment of hydrophobia is based on the fact that 
rabic virus may be intensified or attenuated at will. If successive 
inoculations be made into rabbits with fluid taken either from the 
dog or the monkey, the virulence may be so increased above that 
of a street-dog, requiring from twelve to fourteen days for incuba- 
tion, that after about one hundred inoculations the period of incu- 
bation may be reduced to seven or even six days. This, the most 
powerful virus yet attained, Pasteur termed virus fixe. When pro- 
tected from light and air this virus retains its strength for a long 
period. Pasteur further observed that the cords of rabbits which 
had been dead for some time contained a less virulent poison than 
those of animals freshly killed, especially when the air was dry and 
the cord protected from putrefactive influences, the most efficient 
inoculation being that of an emulsion made from cords exposed to 
dry air for fourteen and ten days, followed by emulsions of cords 
exposed for shorter periods. That the student may more readily 
understand Pasteur's modus operandi, we will cite the case of Joseph 
Meister as treated by the savant : 

" The description of the case of Joseph Meister has now become 
classical. This lad, nine years old, who was the first patient treated 
by this method, was bitten severely on the arms and legs by a mad 
dog on the 4th of July, 1885 ; his worst wounds were cauterized 
with carbolic acid about twelve hours after the bite. The dog was 
undoubtedly mad, and there was little chance of the survival of the 
patient ; it was resolved, therefore, to apply to him the treatment 
which had been so successful in the case of dogs, and to give him 
the only apparent chance of recovery. Thirteen injections were 
made in ten days : two on the first day with emulsions made from 



AL TERA T/VES. 32 1 

cords that had been exposed to dry air for fourteen and ten days 
respectively ; two on the second day with emulsions of cords that 
had been exposed for eleven and eight days respectively, and then, 
on each following day up to the tenth, with emulsions of cords 
exposed for eight, seven, and six days down to one day ; and on 
the last day with that of the fresh cord of a rabbit in which the 
virus retained its full virulence. In order to control the results, for 
every injection that was made into the child a corresponding one 
was made into a rabbit ; and it was found that of the five rabbits 
so inoculated with the first five injecting materials, not one mani- 
fested symptoms of hydrophobia; but the other eight all suc- 
cumbed to the disease, the period at which they died being shorter 
as the cords exposed to the dry air for shorter and shorter times 
were successively injected. The patient, thus gradually prepared 
by the earlier inoculations, was not in the slightest degree affected 
by the stronger virus ; and five years afterward the boy was still 
perfectly well." 

With regard to the administration of serum, several precautions 
are of great importance. The absolute cleanliness of the syringe, 
for example, should be an object of especial care. To this end a 
glass barrel is preferable, in order that impurities may be readily 
detected and removed. For packing purposes rubber or asbestos 
should be employed, and the instrument should be so constructed 
as to permit cleansing and sterilizing of every part before and after 
use. 

The mode of injection and the amount of dosage (measured in 
antitoxin units) vary somewhat according to the nature of the dis- 
ease and the age and susceptibility of the patient. Care should be 
taken to use only the most reliable preparations. 

It has been impossible to present within a necessarily limited 
space the entire field covered by this profoundly interesting subject. 
For a multitude of details, embodying a wide range of experimen- 
tation, and for many expressions of individual opinion awakened 
by a consideration of so absorbing a theme, the student is referred 
to the extensive bibliography relating to every phase of serum- 
therapy. 

It may be readily imagined what would have been the discus- 
sion of Jenner's vaccination had our bacteriological and chemical 
knowledge and delicate appliances for investigation existed in his 
day. It is scarcely surprising, therefore, that the renewal of similar 
studies, after an interval of unprecedented scientific progress, should 
21 



322 A TEXT-BOOK OF MATERIA MEDICA. 

elicit from all parts of the world a zeal and enthusiasm impossible 
in any previous epoch, together with a mass of concurrent or dis- 
senting testimony touching new discoveries proportionate to the 
greatly increased number of competent investigators. Whatever be 
the limitations of serum-therapy, the consensus of opinion among 
thoughtful observers is that its importance to mankind and its pur- 
pose are deeply rooted in the eternal laws of matter and the 
methods of great Nature. Its rationale, its mysterious power, and 
startling phenomena awaken new and greater problems of bacterio- 
logical science ; yet, though the entire subject, embracing as it does 
so ample and momentous a field of inquiry, remains sub judice, the 
character of modern scientific investigation must surely reveal its 
truth or falsity. 






DIVISION III.— ANTISEPTICS. 



Acidum Carbolicum— Acidi Carbolici— Carbolic 
Acid. JJ. S.I>. 

Origin. — A constituent of Coal-tar, obtained by fractional distil- 
lation and subsequently purified. 

Description and Properties. — Colorless, interlaced, or sepa- 
rate, needle-shaped crystals, or a white, crystalline mass, some- 
times acquiring a reddish tint, having a characteristic, somewhat 
aromatic odor, and, when copiously diluted with water, a sweetish 
taste, with a slightly burning after-taste. Deliquescent on exposure 
to damp air. 

Soluble in about 1 5 parts of water, the solubility varying accord- 
ing to the degree of hydration of the acid ; very soluble in alcohol, 
ether, chloroform, benzol, carbon disulphide, glycerin, and fixed and 
volatile oils. It is liquefied by the addition of about 8 per cent. 
of water. The vapor of the acid is highly inflammable. Carbolic 
acid is faintly acid to litmus-paper. It should be kept in dark 
amber-colored, well-stoppered bottles. 

Dose. — \- 2 grains (0.03-0.12 Gm.). If liquefied, 1-2 minims 
(0.03-0.12 Cc). 

Official Preparations. 

Glycerftum Acidi Carb61ici — Glyceriti Acidi CarbSlici — Glycerite of Car- 
bolic Acid (25 per cent.). — For external use. 

Unguentum Acidi Carb61ici— UnguSnti Acidi Carb61ici— Ointment of Car- 
bolic Acid (10 per cent.). — For external use. 

Unofficial Preparations. 

Aqua Acidi Carbftlici— Aquae Acidi Carbftlici— Carbolic Acid Water.— 
Strength, 2 drachms in 1 pint (8.0-473. 17 Cc). Dose, 1-2 fluidrachms (4.0-8.0 Cc). 

Oleum Acidi Carb61ici— Olei Acidi Carb61ici— Carbolated Oil.— 1 in 20 of 
Olive or Cotton Seed Oil. For external use. 

CSrbasus Acidi Carbdlici— CSrbasi Acidi Carb61ici— Carbolic Acid Gauze. 

—Gauze containing Carbolic Acid, 1 ; Resin, 5 ; Paraffin, 7 parts. Used as a surgical 

dressing. 

323 



324 A TEXT-BOOK OF MA TERIA MEDICA. 

Emplastrum Acidi Carb61ici — Empl&strum (ace.) Acidi Carbftlici — Car- 
bolic Acid Plaster. — Composed of Carbolic Acid, 25; Shellac, 75 ; coated with Gutta- 
percha dissolved in Carbon Disulphide. For external use. 

Camphora Carbolisata — Camphorae Carbolisatae — Camphorated Carbolic 
Acid (Phenol-camphor). — Camphor, 2; Carbolic Acid, i; allow to liquefy. A color- 
less, oily liquid, having the odor of camphor, soluble in fixed oils, alcohol, and ether, 
nearly insoluble in water and glycerin. Used as a local anesthetic, chiefly for toothache. 

Liquor Sodii Carbolatus — Liquoris Sodii Carbolati — Phenol-Sodique. — 
Composed of Carbolic Acid, 188 grains (12.5 Gm.) ; Caustic Soda, 31 grains (2.06 Gm.) 
Distilled Water, 4 ounces (118.29 Cc). For external use. 

Liquor Sodii Boratis Comp6situs — Liquoris Sodii Boratis Compdsiti — 
Dobell's Solution. — Composed of Borax and Sodium Bicarbonate, of each, 2 drachms 
(15.0 Gm.) ; Carbolic Acid, 24 grains (1.8 Gm.) ; in Water, I pint (473.17 Cc). Used 
externally in spray. 

Acidum Carb61icum Iodatum (N. F.) — Acidi Carbblici Iodati — Iodized 
Carbolic Acid (Phenol Iodatum). — Composed of Iodine, 20 parts; Carbolic Acid, 
76 parts; Glycerin, 4 parts. The iodine, the acid which has been previously melted, 
and the glycerin are put in a flask, digested at a gentle heat, and frequently agitated 
until the iodine is dissolved. It should be kept in glass-stoppered bottles in a dark 
place. Used locally, especially in gynecological practice. 

Allied Compounds. 

/H 3 (i) 
Cresol. — The cresols, cresylic acid, C 6 H,/ , of which three isomeric com- 

X OH( 3 ) 
pounds are known, are homologues of phenol and derivatives of toluene. They are 
obtained by the distillation of that portion of coal-tar that comes off between 190 - 
2io°C. They are closely combined, the meta-cresol being the most powerful anti- 
septic. They have a strong odor of creosote, and are superior in germicidal power to 
phenol and are less poisonous. Heretofore their insolubility in water has been a hin- 
drance to their employment, but this has been overcome in late years by the addition 
of soaps (lysol, creolin, phenolin, sapocarbol, and saprocresol), or by the addition of 
an alkali, forming cresylates (solveol and solutol), or they have been converted into 
soluble sulfonic acid derivatives (Artmann's creolin, aseptol). 



Antagonists and Incompatibles. — Bromine, metallic salts, 
antipyrine, collodion, alkalies, saccharate of lime or lime, and 
soluble sulphates like Epsom or Glauber salts, are incompatibles. 
Atropine is a physiological antagonist. 

Synergists. — All members of the carbolic-acid group, antisep- 
tics, and motor depressants. 

Physiological Action. — Externally. — Carbolic acid is a local 
anesthetic, and, applied in full strength to animal tissues, acts as a 
caustic, but does not produce vesication. In weaker solutions it 
produces a burning and reddening of the skin. It acts more 
severely upon mucous membranes. It coagulates albumin, and 
therefore its caustic action is limited. 



ANTISEPTICS. 325 

The eschar is first whitish, subsequently becoming brownish. It 
is readily absorbed through the skin or through raw surfaces, and 
toxic effects have been thus produced. Weak solutions are anti- 
pruritic and gratefully cooling and anodyne. It is a disinfectant, a 
deodorant, and a parasiticide. 

Internally. — Digestive System. — In small doses it is cooling and 
sedative to the stomach. In large or poisonous doses it is a pow- 
erful gastro-intestinal irritant. Ordinary medicinal doses are con- 
verted by the gastric contents into the sulphocarbolates. 

Circulatory System. — Medicinal doses have no apparent effect 
on the circulation. Large doses first depress and later accelerate 
the heart. Poisonous doses powerfully depress the heart, stopping 
it in diastole. The arterial tension is lowered by lethal doses, from 
paralysis of the vaso-motor center in the medulla. 

Nervous System. — Medicinal doses have no special effect upon 
the nervous system. Large or poisonous doses depress the cere- 
brum. Vertigo may first be noticed, which is soon followed by 
stupor. Owing to stimulation of the anterior cornua of the spinal 
cord, there may be muscular trembling or convulsions. The 
cornua are ultimately depressed, causing abolition of reflexes and 
paralysis. 

Respiratory System. — Small doses do not affect the respiration. 
Large doses first accelerate the respiratory movements, rendering 
them full, but shallow respirations soon follow. This action is due 
to stimulation of the vagi, both at the periphery and at the center. 
If the dose has been a poisonous one, there is great depression, 
and ultimately paralysis of respiration, due to depression of the 
centers. 

Absorption and Elimination. — It is absorbed from the stomach, 
and diffuses into the blood with great facility, circulating in that 
tissue probably as an alkaline carbolate. 

It is eliminated by all the secretions — chiefly by the kidneys 
and lungs — and appears in the urine as salts of sulphocarbolic and 
glycuronic acids, and to oxidated products of hydrochinon and 
pyrocatechin. To the latter substances mainly is due the pecu- 
liar smoky or olive-green color imparted to the urine after large or 
continued doses have been taken. 

When a very large amount of carbolic acid has been taken, 
some of it can be found in the urine unchanged. 

Temperature. — It is not specially affected by small doses. Full 
medicinal doses tend to lower bodily temperature in fever, while 



326 A TEXT-BOOK OF MA TERIA MEDICA. 

poisonous doses lower the temperature several degrees. The re- 
duction of temperature is due to its diminishing heat-production 
and increasing heat-dissipation. 

Eye. — Poisonous doses almost invariably cause the pupil to be 
minutely contracted, due, probably to paralysis of the radiating 
fibers, the circular fibers being unaffected. 

Untoward Action. — Headache, either in the frontal or the occip- 
ital region, heaviness and a sensation of fulness in the head, dizzi- 
ness, and the appearance of rings before the eyes, muscular weak- 
ness, especially of the legs, profuse sweating, formication. 

Where there is an idiosyncrasy on the part of the individual 
against this drug, small doses even may produce the symptoms of 
poisoning. 

Poisoning. — Carbolic acid is one of the most deadly poisons, 
often equalling hydrocyanic acid in its rapidity of action. 

The patient is rendered rapidly unconscious or may drop dead 
within a very few moments from paralysis of respiration. Should 
the dose be insufficient to produce so sudden a death, the patient 
suffers from all the symptoms of gastro-enteritis — intense pain, with 
violent vomiting and purging. Fibrillary trembling may be present. 
Stertorous breathing appears, with cold, clammy skin, pinched face, 
anxious expression, abolition of reflexes, weak, thready, and often 
imperceptible pulse, feeble respiration, and frequently dyspnea, and 
death finally occurs from failure of respiration. 

Salivation is a common symptom of carbolic-acid poisoning. 

As toxic symptoms may be produced by the external applica- 
tion of solutions of carbolic acid, as in surgical dressings or vaginal 
or intra-uterine douches, the toxicity of this drug should be appre- 
ciated, and patients carefully watched for the first untoward mani- 
festations, such as pain in the lumbar region, smoky urine, nervous- 
ness, and cerebral disturbance, when the drug should be immedi- 
ately withdrawn. 

Treatment of Poisoning. — The immediate administration of mag- 
nesium sulphate (Epsom salts) and warm demulcent drinks should 
be resorted to. The application of external heat. Atropine and 
strychnine hypodermically. Digitalis and coffee may also be re- 
quired. Opium, or some preparation of it, for the relief of pain. 
If the patient is seen soon after the drug has been taken, the stom- 
ach should be washed out, after which the above treatment should 
be followed. 

Alcohol is an efficient antidote if promptly given. Locally 
applied, it prevents the caustic action of even pure phenol. 



ANTISEPTICS. 2> 2 7 

Therapeutics. — Externally and Locally. — For some time after 
it was so prominently brought forward by Lister carbolic acid was 
thought to be indispensable in antiseptic surgery. It is now 
known that the solutions which are safe to use are inefficient, 
ordinarily, beyond the mere mechanical effect of washing. 

The benumbing influence produced on the hands of the sur- 
geon, and the discoloration of bright instruments and rapid impair- 
ment of their cutting surfaces, render strong solutions for disinfect- 
ing instruments impracticable, and indeed of less value for this 
purpose than the prolonged boiling in distilled water rendered 
slightly alkaline with sodium bicarbonate. 

The pain of superficial burns is relieved by applying strong 
solutions of carbolic acid, care being taken to prevent absorption. 

It is an extremely valuable drug as an antipruritic, and is hence 
of great utility in the treatment of certain diseases of the skin — 
pruritus, chronic eczema. In chilblains, tinea tonsurans, t. capitis, 
t. circinata, favus, etc. it is of great value. Chronic laryngitis, cha- 
racterized by diminished secretion, is greatly benefited by the direct 
application to the parts of a solution of \ drachm to I ounce of 
glycerin (2.0-30.0 Cc). A spray containing from 2 to 5 grains 
(0.12-0.36 Gm.) to 1 ounce (30.0 Cc.) of water is an efficient appli- 
cation in the treatment of acute and chronic inflammation of the 
throat and nose. 

Camphorated carbolic acid (campho-phenique) is a useful appli- 
cation in toothache 'due to an exposed and inflamed pulp. 

As a deodorant it is valuable to correct the fetor arising from 
syphilitic ulcerations, carcinoma, gangrene of the lungs, bronchorrhea, 
pneumothorax, etc. 

It reduces the discharge and relieves the pain in acute otitis 
media: a 10 per cent, solution in glycerin should be used. It is 
also of value in the treatment of otorrhea and in acute perforations 
of the tympanic membrane, but should be used in much weaker 
solutions — 1 or 2 per cent. 

A lotion, 8 to 15 grains (0.5-1.0 Gm.) to 1 ounce (30.0 Cc), 
is an efficient antiseptic in foul and indolent ulcers. 

The pure acid is used as a cauterant in chancroids, lupus, gan- 
grene, bites of rabid animals, etc. 

The iodized carbolic acid is a valued local remedy in endometri- 
tis, chronic endocervicitis, and ulcers of the cervix, 

Hiiter in 1878 advocated the use of hypodermic injections of 
a 3 per cent, solution of carbolic acid for erysipelas, the punctures 
to be made at intervals upon the edge of the inflammation. 



328 A TEXT-BOOK OF MATERIA MEDICA. 

Great improvement has taken place in goitre after the treatment 
by hypodermic injections into the tumor of a 5 per cent, solution 
of carbolic acid. 

Internally. — While inferior to salicylic acid to check ferme?itation y 
it is nevertheless used for that purpose in dilatation of the stomach 
and so-called fermentative or flatulent dyspepsia. 

In nervous and irritative vomiting it may be given in doses of 
from 1 to 2 minims (0.06-0,12 Cc), well diluted and repeated at 
intervals of from one to four hours according to the symptoms 
of the case. 

It has been used in acute and chronic dysentery, and as an anthel- 
mintic against ascarides and tcenia solium. 

It has also been advocated as a remedy for typhoid fever and in 
malarial cachexia, but purely upon theoretical grounds, no clinical 
results having thus far justified its use in these disorders. 

Administration. — It may be given internally in pills or capsules, 
mixed with powdered liquorice-root as an excipient, or dissolved in 
glycerin and well diluted with sweetened water. 

For external use various strengths are used (from 1:10 to 
1 : 500), and the various preparations mentioned may be used 
according to the case and indications. It is to be noted that a 
strength above 1 : 10 is liable to produce vesication, and that even 
in 2 per cent, solutions it has caused gangrene of the part to which 
it has for some time been applied. 

Sodii Sulphocarbolas— Sodii Sulphocarbolatis— 
Sodium Sulphocarbolate. U.S.I*. 

Description and Properties. — Colorless, transparent, rhombic 
prisms, odorless, having a cooling, saline, slightly bitter taste. 
Somewhat efflorescent in dry air. Soluble in 4.8 parts of water, 
132 parts of alcohol, 0.7 part of boiling water, and in 10 parts of 
boiling alcohol. The aqueous solution is neutral to litmus-paper. 

Dose. — 10-30 grains (0.60-2 Gm.). 

Allied Compounds. 

Pot3ssii Sulphocarbolas — Pot3ssii Sulphocarbolatis — Potassium Sulpho- 
carbolate. 

Calcii Sulphocarbolas — Calcii Sulphocarbolatis — Calcium Sulphocarbolate. 

Magnesii Sulphocarbolas — Magnesii Sulphocarbolatis — Magnesium Sul- 
phocarbolate. 

Zmci Sulphocarbolas — Zincii Sulphocarbolatis — Zinc Sulphocarbolate. 

All of the above have been employed, but the zinc sulphocarbolate is believed to be 
preferable to check diarrhea and render the stools less foul. It is best given in pills, in 
doses of 2-3 grains (0.1-0.15 Gm.). 



ANTISEPTICS. 329 

Physiological Action. — In medicinal doses sodium sulphocar- 
bolate occasions no special symptoms, and in three or four times 
the medicinal dose it causes only slight lightness of the head. 

It is changed in the system into carbolic acid and sodium sul- 
phate, the latter being eliminated with the urine. The carbolic 
acid set free exerts its characteristic action and influence. 

Therapeutics. — Externally and Locally. — In the strength of 
J drachm (2.0 Gm.) to 8 ounces (237.0 Cc.) of water it forms a 
valuable gargle in relaxed conditioiis of the throat. 

Solutions of different strengths have been used in diphtheria, 
acute tonsillitis, aphtha of children, and nasal catarrh. 

30 grains (2.0 Gm.) in 2 ounces (60.0 Cc.) each, of water, and 
hydrogen peroxide make an efficient injection in gonorrhea. 

Internally. — It is a mild intestinal antiseptic, and may be used 
internally for the same purposes as carbolic acid in such disorders 
as diarrhea, fermentative dyspepsia, etc. It arrests the growth of 
thrush, and is considered by some physicians to exert a favorable 
action in anginose scarlatina, diphtheria, and typhoid fever. The 
zinc sulphocarbolate is one of the best intestinal antiseptics to 
use in cases of dyspeptic diarrhea of children. 

Administration. — Sodium sulphocarbolate is best given in 
solution. 

Creosotum— Creosoti— Creosote. U. S. P. 

Origin. — A mixture of phenols, chiefly Guaiacol and Creosol, 
obtained during the distillation of wood-tar, preferably that of beech. 

Description and Properties. — An almost colorless, yellowish 
or pinkish, highly refractive, oily liquid, having a penetrating 
smoky odor, and a burning, caustic taste ; usually becoming darker 
in tint on exposure to light. Soluble in about 150 parts of water, 
but without forming a perfectly clear solution. With 120 parts of 
hot water it forms a clear liquid which on cooling becomes turbid, 
from the separation of minute oily drops. Soluble in all propor- 
tions in absolute alcohol, in ether, chloroform, benzin, carbon disul- 
phide, acetic acid, and in fixed and volatile oils. Creosote is in- 
flammable, burning with a luminous, smoky flame. It is neutral, 
or only faintly acid, to litmus-paper. 

Tests. — Carbolic acid is often substituted for creosote, and the 
following tests for the detection of carbolic acid are important : 

1. If the suspended liquid is mixed with collodion, a coagulum 
will form if carbolic acid be present. 

2. Carbolic acid produces a violet color with ferric chloride and 



33° A TEXT-BOOK OF MA TERIA MEDICA. 

ammonium hydrate, creosote producing a green color passing to 
brown. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Official Preparation. 

Aqua Creosoti — Aquae Creosoti — Creosote Water.— Dose, 1-4 fluidrachms 
(4.0-15.0 Cc). 

Incompatibles. — Strong sulphuric and nitric acid. It reduces 
silver salts, and explodes when combined with oxide of silver. 

Synergists. — The same as for carbolic acid. 

Physiological Action. — Externally. — It has the same action as 
carbolic acid. 

Internally. — Its action upon the digestive, circulatory, nervous, 
and respiratory systems is practically the same as that of carbolic 
acid. 

It does not stimulate the spinal cord so much as carbolic acid, 
and differs also from the latter drug in increasing the coagulability 
of the blood. Poisonous doses act like those of carbolic acid, but 
with more marked nervous symptoms. 

Absorption and Elimination. — It is eliminated by the bronchial 
mucous membrane, and by the kidneys as guaiacol sulphate and 
creosol sulphate of potassium. 

It is a stimulant expectorant. 

It has the peculiar property when applied to meat of preserving 
it, whence its name (creas, flesh, sohzote, preserve). 

Poisoning. — The symptoms and treatment of poisoning from 
creosote are the same as described under Carbolic Acid. 

Therapeutics. — Externally and Locally. — Creosote is superior 
to carbolic acid as an antipruritic, although not so generally used 
as the latter, on account of its acrid and penetrating odor. It can 
be used externally for the same purposes as carbolic acid. It is a 
valuable hemostatic, and the creosote water may be used for this 
purpose. 

Inhalations of creosote are recommended in phthisis, chronic 
bronchitis, and chronic congestion of the larynx and trachea. It is a 
powerful local anesthetic, and is largely used by dentists and the 
laity for aching teeth. It is used to preserve dead animal matter 
for dissection, etc. 

Internally. — Creosote can be used internally for the same pur- 
poses as carbolic acid, having the advantage over the latter drug in 
being one of the most efficient remedies in pulmonary tuberculosis. 



ANTISEPTICS. 331 

Probably no one remedy exerts so favorable an action upon the 
night-sweats, cough, and expectoration as creosote, or guaiacol, 
which is preferred by many physicians. It is of less value in cases 
accompanied by high temperature and hemoptysis, and often 
aggravates these symptoms. 

It must be remembered that many of the cases alleged to have 
been cured by creosote have been treated with cod liver oil, tonics, 
and hygienic methods as well. 

Contraindications. — The same as for carbolic acid. 

Administration. — Pure beech-wood creosote alone should be 
used. It may be given in the form of creosote water, emulsion, or 
pills, or in capsules mixed with cod liver oil. Capsules are the 
least offensive way of administration. Some persons prefer to take 
the drug in milk. 

In the treatment of phthisis large doses are necessary. A tol- 
erance can usually be established by gradually increasing doses. 
If the patient manifest any untoward symptoms, the drug must be 
reduced in quantity or discontinued altogether. 

Guaiacolum— Guaiacoli— Guaiacol. 

Origin. — As before stated, creosote consists chiefly of Guaiacol, 
Creosols, and Cresols, and of these guaiacol is present to the extent 
of from 60 to 90 per cent. 

Guaiacol is obtained by fractional distillation of beechwood-tar 
Creosote, treated with Ammonia to remove acid compounds, and 
again fractionated. 

Guaiacol is rarely met with absolutely pure. 

Description and Properties. — A colorless, slightly refractive 
liquid, of strongly aromatic odor. Specific gravity at 15 C. 
(59 F.) is 1.1 17. Sparingly soluble in water, but readily soluble 
in alcohol and ether. It is soluble in solutions of sodium and 
potassium hydroxides, forming unstable compounds known as 
sodium- and potassium-guaiacol. 

Tests. — Pure guaiacol will separate rapidly if shaken with twice 
its weight of benzene, whereas the impure article forms a clear 
solution. 

" If a trace of ferric chloride is added to an alcoholic solution 
of guaiacol, a blue color is developed, which changes to emerald- 
green upon the addition of more ferric chloride." 

Dose. — 2-10 minims (0.12-0.6 Cc). 

The following derivatives have been introduced : 



332 A TEXT-BOOK OF MATERIA MEDIC A. 

Guai&coli Benzoas — Guai&coli Benzcatis — Guaiacol Benzoate (Benzosol). 
— Origin, by heating on a water-bath Potassium Guaiacol with Benzosol-chloride : the 
impure benzosol-guaiacol formed is purified by recrystallization from Alcohol. 

Description and Properties. — Colorless, tasteless, and odorless crystalline powder, 
almost insoluble in water, but readily soluble in ether, chloroform, and hot alcohol. 

Dose. — 10-150 grains (0.60-10 Gm.) daily. 

Guai5coli Carbonas — Guai&coli Carbonatis — Guaiacol Carbonate. — Origin, 
this substance is prepared by passing Phosgene Gas (carbonyl chloride) into Guaiacol 
previously dissolved in soda solution. The guaiacol carbonate is formed and is purified 
and crystallized from Alcohol. 

Description and Properties. — White, neutral, crystalline powder, nearly void of odor 
and taste, insoluble in water, slightly soluble in cold and readily soluble in hot alcohol, 
also in ether, chloroform, and benzene, and sparingly soluble in glycerin and fixed 
oils. 

Dose. — 3-60 grains (0.2-4 Gm.) daily, gradually increased. 

Guai3coli Di-iodidum — GuaiScoli Dl-iddidi — Guaiacol Diodide. — Origin, 
by adding a solution of Iodine in potassium iodide to an aqueous solution of Sodium- 
guaiacol as long as precipitation continues. 

Description and Properties. — Reddish-brown salt, having the odor of iodine, soluble 
in alcohol and fixed oils, and readily decomposed. 

Dose. — 2-15 grains (0.10-1 Gm.). 

GuaiScoli Salicylas — GuaiScoli Salicylatis — Guaiacol Salicylate (Guaiacol- 
SALOL). — Origin, by the action of Phosphorous Oxychloride on a mixture of Sodium- 
guaiacol and Salicylate. It is analogous to salol. 

Description and Properties. — White, crystalline, odorless, and tasteless powder, in- 
soluble in water, but soluble in alcohol, ether, and chloroform. 

Dose. — 10-150 grains (0.60-10 Gm.) daily. 

Physiological Action of Guaiacol and its Derivatives. — 
Guaiacol produces an action very similar to that of creosote. It is 
not caustic when applied in full strength. It possesses marked 
antipyretic properties. It is readily absorbed through the unbroken 
skin, and rapidly reduces febrile temperature when applied in this 
manner. The reduction of temperature lasts from four to six 
hours. 

It is a diaphoretic and diuretic. It is excreted by the sweat, 
saliva, and urine, but is only slightly thrown out by the expired 
air, though small amounts of the drug have been found in the 
lung-tissue. As it is eliminated as a salt of ethyl-sulphuric acid, it 
must combine with albuminous bodies in the blood, and chiefly 
through the sulphur present in the albumin molecules. It can be 
found in the urine within fifteen minutes after administration or 
external application in the form of a substance giving the reaction 
of phenol. 

It is more agreeable to the stomach than creosote, and fre- 
quently improves the appetite, though to some patients it is very 
disagreeable and acts as an irritant. 



ANTISEPTICS. 333 

The guaiacol carbonate is usually much better borne by the 
stomach, and is therefore a useful and efficient substitute. 

Benzosol, guaiacol benzoate, contains 54 per cent, of guaia- 
col. It is usually well borne by the patient, and seldom occasions 
any digestive disturbance. In the intestinal canal it resolves into 
guaiacol and benzoic acid, and is excreted by the urine as combi- 
nations of these substances. 

Therapeutics. — Guaiacol is used for the same purposes as 
creosote — less likely to irritate the intestinal canal and kidneys. 

Guaiacol causes a marked reduction of the temperature in cases 
of tubercular disease when applied locally, nor is the antipyretic 
action when thus employed confined to tuberculous cases. It has 
given satisfactory results in other pyrexias. It is a very active 
antipyretic in erysipelas. The temperature begins to fall within 
fifteen or twenty minutes after the application of the drug. As 
with all antipyretics, the depressing action of guaiacol must be 
borne in mind. 

Raymond first suggested the local application of guaiacol in 
tonsillitis. It undoubtedly exerts a favorable action on the disease. 

Guaiacol, or some one of its derivatives, has been substituted 
for creosote in the treatment of phthisis and other wasting forms 
of tuberculosis. Guaiacol itself has no advantage over creosote. 
The benzosol and guaiacol carbonate possess the only advan- 
tage of being tasteless. 

Piatkowski of Vienna recommends benzosol in diabetes mcllitus. 
There have been conflicting reports regarding its efficacy, yet suf- 
ficient is known in its favor to justify a further trial of this drug in 
diabetes. 

Contraindications. — The same as for creosote. 

Administration. — The application of guaiacol for the reduction 
of temperature may be made upon any portion of the skin — the 
back, breast, arms, thighs, or abdomen — without causing any appre- 
ciable difference. From \ to 1 drachm (2.0-4.0 Cc.) is applied 
with a brush, and the part covered with cotton or gutta-percha 
tissue. The application may be repeated as often as necessary for 
the reduction of the fever. 

Other than a decided taste of guaiacol and free diaphoresis, the 
patient usually complains of no untoward symptoms, although in 
some cases quite marked nervous disturbances and other unfavor- 
able manifestations have been observed. 

It may be inhaled from hot water for certain conditions in doses 
of from 5-10 minims (0.3-0.6 Cc). 



334 A TEXT-BOOK OF MATERIA MEDICA. 

The solid derivatives of guaiacol may be given in powders or 
capsules. Guaiacol itself may be given in the same manner as 
creosote — preferably, mixed with cod liver oil or enclosed in cap- 
sules. 

Acidum Salicylicum— Acidi Salicylici— Salicylic 
Acid. U.S. P. 

Origin. — An organic acid, existing naturally in combination in 
various plants like Spircea idmaria (meadow-sweet), Gaultheria 
procumbens (wintergreen), etc., but chiefly prepared synthetically 
by combining the elements of pure Carbolic Acid with dry Car- 
bonic Acid and purifying. 

Description and Properties. — Light, fine, white prismatic 
needles, or a light white crystalline powder, odorless, having a 
sweetish, afterward acrid taste ; permanent in the air. It is soluble 
in about 450 parts of water, in 2.4 parts of alcohol, and in 14 parts 
of boiling water. The addition of 2 parts of sodium sulphite or 
1 part of ammonium phosphate renders it much more soluble in 
water. 

Test. — The addition of ferric chloride to a saturated solution 
produces a fine bluish-violet color. 

Dose. — 3-60 grains (0.25-4.0 Gm.). 

LIthii SalTcylas— Llthii Salicylates— Lithium Salicy- 
late. U. S. JP. 

Origin. — Obtained by heating Salicylic Acid, Lithium Carbonate, 
and Water until effervescence ceases, filtering, and evaporating. 

Description and Properties. — A white or grayish-white pow- 
der, odorless, having a sweetish taste, deliquescent on exposure to 
air, very soluble in water and alcohol. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 

Sodii SalTcylas— Sod ii Salicylatis— Sodium Salicy- 
late. JJ. S. JP. 

Origin. — Prepared by acting on Sodium Carbonate with Salicylic 
Acid, straining, and heating the solution. 

Description and Properties. — A white amorphous powder, odor- 
less, sweetish, saline taste, permanent in air, soluble in 0.9 part of 
water, in 6 parts of alcohol, and in glycerin. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 






ANTISEPTICS. 335 

Antagonists and Incompatibles. — The arterial and cerebral 
stimulants are antagonistic to salicylic acid and the salicylates. 
The incompatibles are the mineral acids, alkalies, metallic salts, 
particularly the ferric salts. 

Synergists. — The carbolic-acid derivatives, anesthetics, cardiac 
depressants, and cerebral sedatives. 

Physiological Action. — Externally and Locally. — Salicylic acid 
is antiseptic, parasiticide, irritant to mucous membranes ; possesses 
the power to soften the epidermis ; checks perspiration when locally 
applied (anhydrotic). 

Internally. — Digestive System. — Small doses stimulate the stom- 
ach ; larger doses act as an irritant. It is an antiferment. 

Circulatory System. — Small doses of salicylic acid have no very 
appreciable effect upon the circulation. Full medicinal doses first 
cause the heart to beat faster and stronger, increasing arterial 
tension ; later the arterial pressure is lowered, and excessive or 
toxic doses cause the pulse to become slow and labored. Its tend- 
ency ultimately, even in medicinal doses, is to depress rather than 
stimulate the heart. Its effect upon the blood is to restrain the 
migration of the white corpuscles. 

Nervous System. — In toxic doses, and in some susceptible per- 
sons in full medicinal doses, salicylic acid causes cerebral conges- 
tion, indicated by a feeling of tension in the cerebrum, headache, 
confusion of thought, tinnitus aurium, vertigo, and sometimes 
delirium. Toxic doses may occasionally produce cerebral con- 
vulsions. It lessens the reflexes, but does not affect the peripheral 
nerves, either motor or sensory. 

Respiratory System. — Small doses stimulate the respiratory cen- 
ter and the pulmonary vagi, making the respiration quicker and 
deeper. Toxic doses paralyze the center and vagi, causing slow 
and labored respiration and death from asphyxia. 

Absorption and Elimination. — Salicylic acid is converted by the 
gastro-intestinal secretions into the sodium salicylate, in which form 
it enters into the circulation. 

It increases the urinary flow. It appears in the urine as sali- 
cyluric acid. The color of the urine is changed to a dark olive- 
green after large doses have been taken. This change is due 
to the presence of indican and pyrocatechin, produced by the 
action of the pancreatic juice upon the salicylic acid in the 
intestine. 



i 



336 A TEXT-BOOK OF MATERIA MEDICA. 

It is a powerful diaphoretic, large doses often causing exhaust- 
ing sweating. It also increases the secretion of milk and the 
amount of sugar in that secretion. 

Elimination takes place slowly by all the emunctories, but 
chiefly through the kidneys and skin. 

Temperature. — Febrile temperature is markedly reduced by large 
doses of salicylic acid. The reduction takes place usually within 
half an hour after a dose has been taken, and lasts several hours. 
The antipyretic action varies in degree according to the cause of 
the pyrexia and the individual susceptibility of the patient. The 
reduction of temperature is produced by lessening heat-production 
and increasing heat-dissipation. 

Untoward Action. — Erythema, urticaria, or petechias, accom- 
panied by intense itching, occasionally edema of the eyelids and 
lower extremities, mental depression, muscular weakness, motor 
disturbances, sweating, and buzzing in the ears, as mentioned under 
Poisoning, but to a less degree. Prolonged administration may 
also produce anemia. 

Poisoning. — There are roaring in the ears, deafness, intense 
headache, vertigo, and possibly delirium, profuse and exhausting 
sweating, subnormal temperature, very weak, compressible pulse, 
feeble and shallow respirations, dimness of vision, ptosis, and often 
strabismus. The blood is disorganized, and the corpuscles rapidly 
break down. The urine and feces pass involuntarily. Death 
usually results from respiratory failure. 

Treatment of Poisoning. — Diffusible stimulants, atropine, strych- 
nine — the same treatment as in poisoning by acetanilid. 

Therapeutics. — Externally and Locally. — Salicylic acid has 
been satisfactorily employed, in the strength of J to I drachm in I 
ounce (2.0 to 4.0 in 32.0 Gm.) of cosmoline, in the treatment of 
erysipelas. 

In the treatment of chancroid salicylic acid has been extensively 
employed. The powdered acid should be thoroughly dusted over 
the surface. 

The peculiar action of salicylic acid in softening and loosening 
thickened masses of epidermis and favoring the normal prolifera- 
tion of epithelium renders the drug especially useful in the treat- 
ment of indurated eczema, particularly of the palm and sole, ver- 
ruca, tylosis, callositas, corns, warts, etc. 

It is one of the most useful drugs in the different varieties of 
eczema, impetigo contagiosa, psoriasis, lupus, parasitic affections, and 
in non-parasitic sycosis it has been employed by Heitzmann with 



ANTISEPTICS. 337 

marked success. It has been used successfully in the treatment 
of acne, comedones , and pruritus. A 3 per cent, solution has been 
recommended in aspergillus of the outer auditory meatus. A 
wash, 3 grains to 1 ounce (0.2 to 30.0 Cc.) is efficient in otorrhea. 
Solutions of various strengths are frequently useful in acute coryza, 
diphtheria, inflammation of fauces, catarrhal stomatitis, and to cor- 
rect offensive expectoration, especially in phthisis and gangrene of the 



Internally. — There is no better example of empiricism in thera- 
peutics than the employment of salicylic acid in acute articular 
rheumatism. Used at first in this disease to reduce temperature, 
it was found that while it exerted marked antipyretic action, it also 
lessened the pain and swelling, and in the majority of cases short- 
ened the duration of the disease. It cannot be classed as a 
" specific " in any sense of the word, but merely relieves certain 
symptoms — fever, pain, and swelling. Other symptoms — or com- 
plications, according to some authors — such as heart affections, are 
uninfluenced by this medicine. Indeed, when so-called cardiac 
complications exist salicylic acid is certainly contraindicated. It 
has no power to prevent either affections of the heart or relapses. 
In the author's opinion, it is doubtful if salicylic acid alone is equal 
to the alkaline treatment or greatly superior to acetanilid or anti- 
pyrine. 

Rheumatic tetanus, irido-choroiditis , and sclerotitis are alleged to 
have been cured by this drug. It is useless in gout, according 
to the best English authorities, and is of no value in chronic or 
gonorrheal rheumatism, rheumatic arthritis, or rheumatic hyper- 
pyrexia. 

It is credited with being quite efficient in chorea of rheumatic 
origin, and in relieving the pains of herpes zoster and neuralgic 
headache. 

It is a drug to be tried in many diseases of rheumatic origin, 
unless some distinct contraindication to its use exists. It surpasses 
any drug, with the possible exception of guaiac, in the treatment 
of quinsy, and particularly rheumatic tonsillitis. The medicine is 
highly regarded by competent advocates as a remedy in diphtheria. 
Lumbago often yields to its influence, and it has also been recom- 
mended in sciatica, although in Cook County Hospital the author 
has seen a great number of cases of the latter treated with salicylic 
acid without any apparent improvement. He also regards it as 
valueless in typhoid and intermittent fevers. 
22 



338 A TEXT-BOOK OF MATERIA MEDIC A. 

It is a useful antizymotic to prevent putrefactive fermentation 
and flatulence, and lessen thereby the tendency to crapulous diar- 
rhea. 

Owing to the similarity of its action to that of quinine, it has 
been used, and with some success, in periodical neuralgias which 
have not responded to the latter drug. 

It has been found of use in influenza, and is an efficient anti- 
septic remedy in chronic gastric catarrh, diarrhea, cholera, and 
entero-colitis. By some eminent clinicians it is considered to be 
one of the most effectual remedies in pleurisy with effusion. 

It has been recommended as an effectual anthelmintic, both for 
tape- and round-worms. 

Contraindications. — Salicylic acid should not be given in large 
doses to persons who have a weak heart or are otherwise greatly 
debilitated, at least not without counteracting its toxical tendencies 
with nutrients and diffusible stimulants. 

Administration. — Owing to its irritant action upon the mucous 
membranes, it is best given in a solution of glycerin and some aro- 
matic water, after meals. So concentrated a form as a pill or cap- 
sule is not recommended. 

Many of the untoward cerebral effects may be relieved by giving 
20 grains (1.3 Gm.) of sodium or potassium bromide. 

Many of the toxical effects have been attributed to an impurity 
in the manufactured acid. 

If any benefit is to be derived from salicylic acid in acute artic- 
ular rheumatism, it must be used early in the disease and in heroic 
doses at comparatively frequent intervals — not less than 20 grains 
(1.3 Gm.) every two, three, or four hours for an adult. If too 
serious gastric and cerebral symptoms manifest themselves, the 
drug may be decreased in amount or discontinued until the 
unpleasant action subsides. 

It is better, except in acute articular rheumatism, to give a 
small dose, repeated frequently, than to administer a full dose at 
once. 

The physiological action and therapeutics of lithium salic- 
ylate are practically the same as those of salicylic acid or sodium 
salicylate. It is, however, richer in salicylic acid than the sodium 
salt, and in gout and chronic rheumatism has been found to be of 
more value than salicylic acid. 

It should be given in solution. 

Sodium salicylate is identical in physiological action and 



ANTISEPTICS. 339 

uses with salicylic acid, with the exception that it is less irritating 
to the stomach, and is therefore ordinarily to be preferred to the 
acid. 

It may be prescribed in aromatic water, in syrup, or in powder, 
pills, or capsules. 

Salol-Salol-Salol. U. S. P. 

(Phenyl Salicylate.) 

Origin. — The Salicylic Ether of Phenol, prepared by heating 
Salicylic Acid with Phenol in the presence of Phosphorus Penta- 
chloride. 

Description and Properties. — A white, crystalline powder, 
odorless, or having a faintly aromatic odor, and almost tasteless. 
Permanent in the air. Almost insoluble in water; soluble in 10 
parts of alcohol ; also in 0.3 part of ether, and readily in chloro- 
form and in fixed or volatile oils. 

Dose. — 3-15 grains (0.19-1.0 Gm.). 

Physiological Action. — Externally and Locally. — It is a more 
powerful antiseptic than either of its constituents. Nencki claims 
that it is not a germicide, as it will not destroy bacteria when 
present, although it prevents their formation. It is not, like sali- 
cylic acid, irritating to the mucous membranes. 

Internally. — The action of salol is essentially like that of salicylic 
acid, but it is a more powerful antipyretic, analgesic, and cerebro- 
spinal sedative. It reduces temperature much more promptly, the 
antipyretic action occurring within fifteen minutes after a full medi- 
cinal dose has been taken. The effect, however, is not prolonged, 
repeated doses being required to maintain the reduction of tern- 
perature. 

The circulation is, perhaps, not so much depressed as by sali- 
cylic acid. The respirations are at first quite rapidly increased, and 
are rendered very shallow, requiring some time to resume their 
normal condition. 

It is converted by the pancreatic and intestinal juices into its 
original constituents — salicylic acid and carbolic acid. It is usu- 
ally absorbed and eliminated very rapidly, having been detected 
in the urine in the form of salicyluric acid and phenol-ether-sul- 
phuric acid within thirty minutes after its ingestion by the stomach. 
To the latter acid is due the dark, smoky color of the urine which 
sometimes exists under large or continued doses of salol. 

Therapeutics. — Externally and Locally. — Salol is especially 



340 A TEXT-BOOK OF MA TERIA MEDICA. 

recommended as an antiseptic dressing for wounds, burns, venereal 
ulcers, and buboes. Powdered salol or an ointment — I part to 150 
parts of petrolatum — has been used in cases of tubercular laryngitis 
and ozena. Like salicylic acid, it is also of value in eczema and 
sycosis simplex. 

Internally. — It is an efficient remedy in all diseases benefited by 
the internal administration of salicylic acid. In addition to these 
services it is a valuable remedy in acute and chronic cystitis, gonor- 
rhea, intestinal catarrh, especially duodenal catarrh and catarrhal 
jaundice, and to relieve the pains of neuritis and myalgia. 

Salol is much more useful than salicylic acid in diarrhea, cholera 
morbus, and cholera, the latter disease yielding better, perhaps, to 
this remedy than to any other. 

Administration. — It may be given in pills, capsules, powders, 
emulsion, or suspended in milk. The compressed tablets of this 
drug so extensively used at present are not recommended, owing 
to their slow and difficult solution. 

Allied, Compounds. 

The compounds of salicylic acid are extremely numerous. It is beyond the purpose 
of the present volume to mention them all, but the following have been employed widely 
and have something in their favor as remedial agents : Salacetol, resembling salol, an 
acetone radicle replacing the phenyl in that compound. Used for the same purposes in 
doses of 30-45 grains (2-3 Gm.). Salicyt 'amid is tasteless, more soluble than salicylic 
acid, and more active. Dose, 2-5 grains (0.1-O.3 Gm.). Salifebrin, acetanilid and 
salicylic acid; not reliable. Saligenin, a substitute for salicin in doses of 8-15 grains 
(0.5-1 Gm.). Salipyrine, antipyrine and salicylic acid, has the combined effects of its 
constituents, and is an efficient drug in doses of 15-30 grains (1-2 Gm.). Salophen, 
resembling salol somewhat, but phenol in different form, acetyl p-amidophenol. Dose t 
15-30 grains (1-2 Gm.). 

Saliclnum— Salicini— Salicin. U. S. -P. 

Origin. — A Glucosid obtained from several species of Salix 
(willow) and Populus (poplar). 

Description and Properties. — Colorless or white, silky, shining, 
crystalline needles, or a crystalline powder, odorless and having a 
very bitter taste. Permanent in the air. Soluble in 28 parts of 
water, 30 parts of alcohol, 0.7 part of boiling water, and in 2 parts 
of boiling alcohol. 

Dose. — 10 grains-2 drachms (0.6-8.0 Gm.). 

Physiological Action. — Its physiological effect is analogous to 
that of salicylic acid, but is much less active than the latter. It 
does not disturb digestion, but in moderate doses promotes appe- 



ANTISEPTICS. 341 

tite and acts like other bitters. It is more rapidly absorbed than 
salicylic acid, is partly decomposed, and is found in the urine, as 
salicin and salicylic acid, in from fifteen to thirty minutes after the 
ingestion of a single dose. 

Therapeutics.— While inferior to salicylic acid in most respects, 
salicin is frequently used for the same purposes. It is superior to, 
and safer than, salicylic acid in acute rheumatism characterized by 
a weak heart and depressed vaso-motor system. 

It is an excellent stomachic tonic, and may be used like other 
bitters in the treatment of atonic dyspepsia and other conditions 
benefited by this class of drugs. 

Contraindications. — In acute inflammatory affections of the 
brain and ear. 

Administration. — Salicin may be administered in powders, cap- 
sules, or solution. Owing, however, to its bulk and intensely bitter 
taste, it is perhaps best given in suspension in the aromatic elixir 
of liquorice or in syrup of yerba santa. 

Naphtallnum— Naphtallni— Naphtalin. U. S. JP. 

Origin. — A hydrocarbon obtained from coal-tar. 

Description and Properties. — Colorless, shining, transparent 
laminae, having a strong, characteristic odor resembling that of 
coal-tar, and a burning, aromatic taste ; slowly volatilized on expo- 
sure to air. Insoluble in water, but when boiled in it imparting a 
faint odor and taste. Soluble in 15 parts of alcohol, and very 
soluble in boiling alcohol ; also very soluble in ether, chloroform, 
carbon disulphide, and in fixed or volatile oils. Naphtalin vola- 
tilizes slowly at ordinary temperatures, but rapidly when heated. 
Its vapor is inflammable, burning with a luminous and smoky 
flame. It should be kept in well-stoppered bottles. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Naphtol-Naphtol-Naphtol. U. 8. P. 

(Beta-naphtol.) 

Origin. — A phenol occurring in coal-tar, but usually prepared 
artificially from naphtalin. 

Description and Properties. — Colorless or pale buff-colored, 
shining, crystalline laminae, or a white or yellowish-white crystal- 
line powder, having a faint, phenol-like odor, and a sharp, pungent, 
but not persistent taste. Permanent in the air. Soluble in about 
1000 parts of water, in 0.75 part of alcohol, in about 75 parts of 



342 A TEXT-BOOK OF MATERIA MEDICA. 

boiling water, and very soluble in boiling alcohol, ether, chloro- 
form, and solutions of caustic alkalies. It should be kept in dark 
amber-colored, well-stoppered bottles. 
Dose. — 2-10 grains (0.12-0.6 Gm.). 

Allied Compounds. 

Aliimnol. — An almost colorless, non-hygroscopic powder; readily soluble in cold 
water or glycerin, less soluble in alcohol, and insoluble in ether. It is employed as a 
local remedy in solutions varying in strength from I to 50 per cent. Used externally. 

Asaprol. — A colorless, neutral crystalline powder, soluble in \\ parts of water and 
in 3 parts of alcohol. — Dose, 15-60 grains (1.0-4.0 Gm.). 

Benzonaphtol. — Obtained by the action of Benzoic Chloride on Beta-naphtol in a 
sand-bath. It is an odorless, tasteless, white, crystalline powder, or occurs in the form 
of long needles. Insoluble in cold water. Dose, 4-8 grains (0.18-0.5 Gm.). 

Betol (Naphtos&lol — Salinaphtol). — A substance analogous to salol, and pre- 
pared in the same manner, except that sodium-naphtol is used instead of sodium-phenol. 
It occurs as a colorless, odorless, tasteless, lustrous crystalline powder. Insoluble in 
water or glycerin, and with difficulty soluble in cold alcohol. Dose, 2-5 grains (0.12- 
0.3 Gm.). 

Camphorated Naphtol. — Obtained by mixing 1 part of Beta-naphtol with 2 parts 
of Camphor. It is a brownish, transparent, syrupy liquid. 

Hydronaphtol. — A derivative of beta-naphtol, obtained by the action of reducing 
agents. It occurs in scale-like crystals, of a silvery white or grayish hue, of slightly 
aromatic odor and taste. Soluble in 1100 parts of water, and freely soluble in alcohol, 
ether, glycerin, benzene, chloroform, and fixed oils. Dose, 2-3 grains (0.12-0. 18 Gm.). 



Antagonists and Incompatibles. — Physiological antagonists 
of naphtalin are the same as for other members of this group. 
Naphtol is incompatible with subacetate of lead. 

Synergists. — Carbolic acid and its derivatives. 

Physiological Action. — Naphtalin is antiseptic, antifermenta- 
tive, disinfectant, and deodorant. Its action is quite similar to 
salol, it being insoluble in the gastric juices but to some extent 
soluble in the intestines, where it acts as an antiseptic by local 
contact, deodorizing the stools and often imparting to them its own 
odor. It is absorbed to some extent, and is eliminated by the lungs 
and kidneys, but escapes principally in the feces. It is broken up 
into naphtol or phenol, and acts as a local antiseptic and disinfec- 
tant at points of elimination, but does not occasion any local irri- 
tation unless quite large doses have been taken: "15 grains 
(1.0 Gm.) daily have occasioned frequent micturition, with burning 
pain, vesical tenesmus, and redness of the urethral orifice." Purdy 
states that in certain cases of genito-urinary disease he has known a 
dose of 5 grains (0.32 Gm.) to cause severe suffering along the whole 
urinary tract. It is a stimulant expectorant, and differs from other 
members of the group in that it possesses no antipyretic action. 



ANTISEPTICS. 343 

Naphtol is quickly absorbed when applied locally. It produces 
considerable irritation when used in solution, but has no irritating 
effect when applied in the form of ointment. Toxic effects may 
result from its absorption by the skin, their character resembling 
the action of carbolic acid. 

Altimnol. — An astringent antiseptic. 

Xsaprol. — An antipyretic, analgesic, and antiseptic. It is considered superior to 
the salicylates in these respects, having the advantage of neither exciting vomiting nor 
disturbing the brain or the auditory apparatus. 

Benzonaphtol. — Antiseptic, diuretic, and but slightly poisonous. 

Betol. — Action almost identical with that of salol. 

Hydronaphtol. — A powerful non-irritating, non-corrosive, and non-poisonous anti- 
septic, said by Dr. Fowler to possess " antiseptic properties fifteen times greater than 
carbolic acid." l Dr. Levis claims that it is thirty times as antiseptic as salicylic acid, 
and that this property exceeds that of boric acid sixty times, of alcohol six hundred 
times, and that in this respect it ranks next to mercuric chloride. 

Therapeutics. — Externally and Locally . — Naphtalin in alcoholic 
solution is advised by Henri Laserre in the treatment of chronic 
abscesses and adenitis. It is also recommended in the treatment of 
scabies and other parasitic skin diseases. 

hiternally. — It is used in typhoid fever and in the gastro-intestinal 
and genito-urinary disorders for which salol and carbolic acid are 
administered, such as chronic diarrhea and dyse?ttery y acute or 
chronic cystitis, etc. 

The internal uses of naphtol are the same as those of naphtalin, 
while externally it may be employed, like carbolic acid or creasote, 
as a general antiseptic in cutaneous disorders, whether organic or 
parasitic, 

Altimnol. — An efficient remedy in many acute and chronic inflammatory diseases 
of the skin, and in gonorrhea, chancres, syphilitic ulcers, balanitis, etc. A I per cent, 
solution may be injected in gonorrhea, while stronger solutions (10-50 per cent.), or 
alumnol plaster, are recommended in chronic diseases of the skin. 

Asaprol. — Given for the same purposes as salicylic acid and the salicylates, although 
it is not so uniformly successful in acute articular rheumatism, while having the advan- 
tage of causing less heart-depression. 

Betol. — Used chiefly in the bowel complaints of children. It may be administered 
either by the mouth or through the rectum, associated with bismuth or antacids. It has 
been used also in acute articular rheumatism and bladder affections. 

Camphorated naphtol is considered by some practitioners to be superior to all 
other remedies to prevent suppuration in acute tonsillitis. 

Fernet has employed it successfully in tubercular ulcerations of the tongue, while 
Reboul of Marseilles and others have adopted it with good effect hypodermically in 
tuberculous adenitis and tuberculosis of the testis. It has also been used in tuberculosis 
of the bladder, joints, etc. 

1 New York Med. Joum., Oct. 3, 1885. 



344 A TEXT-BOOK OF MA TERIA MEDICA. 

Ruault claims it to be an efficient local application to the turbinated bones in 
ozena. 

Hydronaphtol. — Considered by many physicians to be superior to carbolic acid, 
since it is without disagreeable odor and can be used without exciting irritation or 
danger of toxic impression. 

Dockrell employs it in the form of a plaster for destroying the trichophyton fungus 
of tinea tonsurans, and believes it to be superior to mercuric chloride as a germicide. 

It'has been used as a preventive of dental caries, and in the treatment of gingivitis, 
pyorrhoea alveolaris, diphtheria, etc. 

Internally it has been recommended in dysentery, diarrhea, pulmonary tuberculosis t 
and typhoid fever. 

Contraindications. — These preparations should not be given 
internally when the functional activity of the kidneys is defective. 

Administration. — Naphtalin is best given internally in the 
form of pills or in capsules. When it is necessary to use it topi- 
cally, the offensive odor of the drug may be disguised, it is said, by 
triturating it with a small quantity of the oil of bergamot. Naphtol 
should be given in capsules, in the dose recommended, three times 
a day or oftener if necessary. 

Asaprol, betol, and hydronaphtol are best given in capsules, 
although betol, which is tasteless and insoluble in water, may be 
administered in the form of powders. 

Resorcinum— ResorcTni— Resorcin. TJ. S. P. 

Origin. — Prepared by melting Galbanum, Ammoniac, or Guai- 
acum Resin with Potassa. It is also prepared in a similar mariner 
from Asafetida, Sagapenum, Ascaroid Resin, and from Phenol- 
sulphonic Acid and other derivatives of Phenol. 

Description and Properties. — Colorless or faintly reddish, needle^ 
shaped crystals, or rhombic plates, having a faint, peculiar odor, 
and a disagreeable sweetish and afterward pungent taste. Resorcin 
acquires a reddish or brownish tint by exposure to light and air, 
and should be kept in dark amber-colored vials. It is soluble in 
0.6 part of water, 0.5 part of alcohol, very soluble in boiling water 
and in boiling alcohol, readily soluble in ether and in glycerin, and 
very slightly soluble in chloroform. The aqueous solution is neutral 
or only faintly acid to litmus-paper. 

Dose. — 3-8 grains (0.2-0.5 Gm.). 

Allied and Derivative Compounds. 

Hydroqulnol — Hydroqulnone — HydrochTrione — Paradioxybenzene. — Color- 
less, odorless, dimorphous crystals, having a sweetish taste. Soluble in 17 parts of water, 
and very soluble in hot water, alcohol, and ether. Dose, 1^—5 grains (0.03-0.30 Gm.). 



ANTISEPTICS. 345 

Catechol — Pyrocate'chin — Orthodioxybenzene. — Acicular crystals, readily solu- 
ble in water, alcohol, and ether. 

Other allied compounds are — Thioresorcin, Resopyrine, and Fluorescein. 

Antagonists. — Cerebral excitants, cardiac and respiratory stim- 
ulants. 

Synergists. — Salicylic acid, quinine, carbolic acid. 

Physiological Action. — Externally and Locally. — Resorcin is an 
antiferment, antiseptic, deodorant, a feeble analgesic, and a parasiti- 
cide. Applied to the unbroken skin, it is non-irritating, is not ab- 
sorbed by it, and when injected into the subcutaneous tissues 
produces but little irritation, with no suppuration. Applied to the 
moistened mucous membrane, its action is similar to that of car- 
bolic acid, producing vesication, etc. 

Internally. — The physiological properties of resorcin are allied 
to those of carbolic acid. It possesses more marked antipyretic 
and diaphoretic actions than carbolic acid, but when used to pro- 
duce these effects it greatly depresses the heart. 

Its chief action is on the nervous system, which it first power- 
fully stimulates and then depresses. 

It is mainly and rapidly eliminated by the urine, which it colors 
an olive-green or bluish-violet hue. 

Poisoning. — Poisonous doses produce vertigo, ringing in the 
ears, deafness, disturbance of vision, weak, rapid, and irregular pulse, 
respiration at first convulsive and jerking, afterward accelerated, 
shallow, and weak, death resulting finally from respiratory failure. 
There are great mental anxiety, epileptiform convulsions, collapse, 
and unconsciousness. Just before death there is a rise in temper- 
ature, doubtless due to excessive muscular action, although the 
temperature may fall below normal if there is quiet narcosis, as 
there may be in some instances. 

Treatment of Poisoning. — Hypodermic injections of atropine. 
The administration of diffusible stimulants. Artificial respiration. 

Therapeutics. — Externally and Locally. — Resorcin is especially 
useful in certain subacute or chronic skin affections, and may be 
used like salicylic acid in indurated eczema. It is of great value in 
psoriasis, seborrhcea sicca, pityriasis capitis, sycosis, acne rosacea, etc. 

A 5 to i o percent, solution is an efficient application in pharyn- 
gitis, diphtheria, and ulcerative laryngitis. An ointment of resorcin 
is an excellent application to foul ulcers, sloughing wounds, and 
syphilitic ulcers. 

Condylomata have been cured by dusting upon them powdered 
resorcin. 



346 A TEXT-BOOK OP MATERIA MEDICA. 

A mixture of powdered resorcin and boric acid (i : 20 or 1 : 10) 
has been used with brilliant results in suppuration of the middle ear. 

A 2 per cent solution has been found useful in the form of a 
spray in whooping cough, while stronger solutions of 10 or 20 per 
cent, have been used with some success in hay fever. 

Solutions of resorcin have been used in gonorrhea and cystitis. 

Internally. — Resorcin is preferable to carbolic acid for internal 
administration, especially in digestive disorders such as gastralgia, 
chronic gastritis, ulcer of the stomach, and fermentative dyspepsia, so 
called. Owing to its sedative and antifermentative properties, it is 
of value in acute diarrhea of children. 

It has been used with some success in intermittent fever, but 
not with good results sufficiently uniform to justify the exclusion 
of quinine. As an antipyretic it may be used when a drug of that 
character is indicated, but it is not equal to antipyrine or acetanilid, 
and in doses sufficient to produce the desired reduction of temper- 
ature it is too depressant to the heart. Its chief therapeutic value 
is for external or local use, and internally for the digestive disorders 
above mentioned. 

Administration. — It should be given in pills or capsules. 

Ichthyolum— Ichthyoli— Ichthyol. (Unofficial.) 

Origin. — It is obtained by the destructive distillation of bitumin- 
ous rock found near Seefeld in the Tyrolese Alps, which contains 
enormous quantities of semi-fossilized fishes and marine animals. 

Description and Properties. — It occurs in the form of a brown- 
ish-yellow, transparent, oily liquid, containing about 10 per cent, of 
sulphur. 

Upon being treated with concentrated sulphuric acid ichthyol 
is converted into ichthyol-sulphonic acid, which readily combines 
with ammonia and other alkalies, as well as with lithium, zinc, 
mercury, etc., forming the ammonium ichthyol, sodium ichthyol, 
zinc ichthyol, etc. 

Ammonium ichthyol occurs as a clear reddish-brown, syrupy 
liquid with a bituminous odor and taste. Soluble in water and in 
a mixture of equal volumes of ether and alcohol. 

Dose. — 2-10 minims (0.12-0.6 Cc). 

The other salts of ichthyol-sulphonic acid occur as brownish or 
black tar-like masses, the sodium salt being the most important, 
as it is the one most employed when ichthyol is desirable in pill 
form. 

Dose. — Sodium ichthyol, 2-4 grains (0.1-0.25 Gm.). 



ANTISEPTICS. 347 

Allied Drugs. 

Thiolum — Thloli — Thiol. — Origin. — This substance is prepared by heating 
brown-colored paraffin or gas oils with Sulphur, and extracting the sulphurated, unsatu- 
rated hydrocarbons with Alcohol. 

Description and Properties. — It occurs as a neutral, solid body, non-hygroscopic 
and soluble in water, and of a dark-brown color, or in the form of a dark reddish- 
brown, syrupy liquid, containing about 40 per cent, of thiol. 

Dose. — \- 1 grain (0.03-0.06 Gm.). 

Tumenolum — Tumenoli — Tumenol. — Origin. — It is obtained from purified 
mineral oils by the direct action of concentrated sulphuric acid, without previous sul- 
phuration, being a mixture of sulphones and sulphonic acids. 

Description and Properties. — A dark-brown or blackish-brown liquid of a syrupy 
consistency. 

Dose. — It is used only externally, in strengths of from 5 to 10 per cent. 

Antagonists and Incompatibles. — Ichthyol possesses marked 
reducing properties, and should not therefore be combined with 
substances, like potassium permanganate, which part readily with 
oxygen. 

Synergists. — Most members of this group, particularly the tars, 
carbolic acid, creasote, etc., aid its action. 

Physiological Action. — Externally and Locally. — Ichthyol is 
ischemic, sedative, parasiticide, and possesses antiseptic and prob- 
ably disinfectant properties. 

When applied to the skin in full strength it produces some irri- 
tation. It is readily absorbed, having the power to penetrate the 
skin, affecting the deeper tissues beneath. 

Internally. — Digestive System. — Very large doses produce con- 
siderable gastro-intestinal irritation. 

Circidatory System. — It has the power in medicinal doses of 
contracting the caliber of the arteries, and in large doses it increases 
the migration of the white blood-corpuscles. 

The physiological action has not been fully studied, and it is 
not yet positively known what action it has upon the nervous and 
respiratory systems and upon temperature. 

Therapeutics. — Externally and Locally. — Ichthyol was intro- 
duced by Unna as a valuable remedy in certain diseases of the 
skin. It is particularly useful in erythematous eczema, erysipelas, 
lupus erythematosus, irritable acne, and certain forms of acne rosacea. 

Agnew has employed it with advantage in lymphatic enlarge- 
ments. It has also been found useful in synovial inflammations % in- 
flammatory conditions of the female genital organs, and in certain 
diseases of the ear and nose. 

Thiol, although inferior, is similar to ichthyol in its therapeutic 



348 A TEXT-BOOK OF MATERIA MEDICA. 

action. It has been found to be valuable in the treatment of herpes 
zoster, dermatitis herpetiformis, and erythema multiforme. 

Administration. — Ichthyol, when given internally, should be 
dispensed in capsules, while thiol may be given in capsules, pills, 
or wine. 

Externally, ichthyol may be employed in solution, dissolved in 
chloroform or in a mixture of alcohol and ether, and applied with 
a brush ; or in the form of an ointment mixed with soft petrolatum 
or lanolin in from 1-4 to 8 drachms (4.0-15.0 Cc. to 32.0 Gm.). It 
is used also in the form of a soap in from 5 to 20 per cent, strength. 

Thiol is used locally in powder form, or as an ointment of 5 to 
10 per cent, of the liquid, or in collodion containing 5 per cent, of 
the powder, or in solutions of glycerin and aqueous solutions con- 
taining from 5 to 50 per cent, of the powder. 

Iodoformum— Iodoformi— Iodoform. JJ. S.I*. 

Origin. — It is obtained by the action of Iodine, in the presence 
of fixed alkalies or alkali carbonates, upon Alcohol or Acetic and 
other easily-saponifiable Ethers. 

Description and Properties. — Small, lemon-yellow, lustrous 
crystals, of the hexagonal system, having a peculiar, very pene- 
trating, and persistent odor, somewhat resembling that of saffron 
and iodine, and an unpleasant, slightly sweetish, and iodine-like 
taste. It is very slightly soluble in water, to which, however, it 
imparts its odor and taste; soluble in about 52 parts of alcohol, in 
about 12 parts of boiling alcohol, or in 5.2 parts of ether, and very 
soluble in chloroform, benzin, and fixed and volatile oils. 

Iodoform is slightly volatile, even at ordinary temperatures, and 
in boiling water distils slowly over with its vapor. It should be 
kept in well-stoppered bottles, in a cool and dark place. 

Iodoform contains 96.69 per cent, of its weight as iodine. 

Dose. — 1-3 grains (0.06-0.2 Gm.). 

Official Preparation. 

UnguSntum Iodof6rmi — UnguSnti Iodoftfrmi — Ointment of Iodoform. — 10 

per cent. Used externally. 

Allied Compounds. 

AntisSptol — Cinchonine Iodosulphate. — Origin. — It is prepared by mixing an 
aqueous solution of Cinchonine Sulphate with an aqueous solution of Iodine and Potas- 
sium Iodide, and washing and drying the resulting precipitate. 

Description and Properties. — It occurs as a light reddish-brown powder, insoluble in 
water, but soluble in alcohol and chloroform. It contains about 50 per cent, of iodine. 



ANTISEPTICS. 349 

Dose. — 1-3 grains (0.06-0.2 Gm.). 

Aristol — Dithymol Di-iodide. — Origin. — It is obtained by adding a solution of 
iodated Iodide of Potassium to an aqueous solution of Hydrate of Sodium containing 
thymol. The resulting precipitate is washed and subsequently dried at ordinary tem- 
perature. 

Description and Properties. — A dark, brownish-red, amorphous, almost tasteless 
powder, of a slight, peculiar, iodine-like odor, insoluble in water and glycerin, sparingly 
soluble in alcohol, but readily soluble in ether, collodion, and chloroform. It is also 
taken up by fixed oils, petrolatum, etc. 

Aristol is decomposed by heat and light, and it should be kept in dark amber- 
colored, well-stoppered bottles. It contains 45.8 per cent, of iodine. 

Dose. — It is not given internally. 

Europhen. — Prepared in a manner analogous to that of preparing aristol, except 
that isobutylorthocresol is used in place of thymol. 

Description and Properties. — An amorphous, yellow powder, having an odor resem- 
bling saffron ; soluble in ether, chloroform, and fixed oils ; insoluble in water and 
glycerin. It is permanent in dry air, but when moistened with water resolves into iodine, 
forming a new soluble iodine compound. When heated to no C. (230 F.) it melts, 
forming a clear brown liquid. It contains 27.6 per cent, of iodine. 

Dose. — ^-i\ grains (0.016-0.09 Gm.). It is used hypodermically in olive oil, and 
externally in the form of an ointment, in strengths varying from 3 to 10 per cent. 

Antagonists and Incompatibles. — It is incompatible with the preparations of mercury 
and zinc, with metallic oxides, and with starch. 

Iodol. — Origin.— Obtained by the interaction of Iodine and Pyrrol (a constituent of 
mineral oil) in Alcoholic Solution for twenty-four hours, the iodol being precipitated upon 
the addition of Water; or it may be prepared after the manner of preparing aristol, 
except that Pyrrol is used instead of Thymol. 

Description and Properties. — It is a pale-yellow or grayish-brown, more or less 
crystalline, bulky, tasteless, and odorless powder. It is insoluble in water, and but 
slightly soluble in diluted alcohol. It is soluble in alcohol and ether. The alcoholic 
solution is miscible with glycerin, but when mixed with water a milky precipitate is 
formed. Iodol contains 88.97 P er cent, of iodine. 

Dose. — I £-2 grains (0.03-0.12 Gm.). 

Ltfsophan. — Origin. — Prepared by slowly adding an aqueous solution of Iodine and 
Iodide of Potassium to an aqueous solution of Ortho-oxyparatoluic Acid and Sodium Bicar- 
bonate. The precipitate formed is washed with Water and recrystallized from Alcohol. 

Description and Properties. — It occurs as colorless, odorless, needle-shaped crystals. 
Insoluble in water and alcohol, but readily soluble in ether, benzene, chloroform, and 
fixed oils. It contains 78.39 per cent, of iodine. 

Dose. — It is used externally. 

SozoTodol. — Origin. — A combination of Iodine 54 per cent., Carbolic Acid 20 per 
cent., and Sulphur 7 per cent. 

Description and Properties. — The sodium, potassium, ammonium, mercury, lead, and 
zinc salts of this acid are the preparations used, the sodium salt being the one most 
commonly employed. The sodium sozoiodolate occurs in bright, prismatic, needle-shaped 
crystals. Soluble in water, alcohol, and glycerin. 

Dose. — For external use, in strengths varying from 3 to 20 per cent. 

Sulphaminol. — Origin. — It is formed by the action of Sulphur on the salts of Meta- 
oxydiphenylamine. 

Description and Properties. — It is a yellow powder, insoluble in water, readily solu- 
ble in alkalies, alcohol, and glacial acetic acid. 

Dose. — 1-4 grains (0.006-0.25 Gm.). 



350 A TEXT-BOOK OF MATERIA MEDIC A. 

Other compounds of iodine used for much the same purposes are : Iatrol, aniline 
iodine, an antiseptic powder; ImJdiod, a substitute for iodoform; Iodoanisol, a rube- 
facient and antiseptic; lodo-casein, a yellow powder with faint iodine odor; Iodocrol, 
carvol and potassium iodide and soda ; odorless substitute for iodoform ; lodoformal, 
with odor like vanilla, also an iodoform substitute ; Iodoformogen, albumin and iodo- 
form ; lodogallicin, bismuth iodide and gallicin, antiseptic ; lodoierpin, iodin and terpin, 
dark-brown liquid, substitute for tincture of iodine or iodoform; Iodothymoform, an 
iodized thymol-formaldehyd preparation, a yellow powder rich in iodine. 

Antagonists and Incompatibles. — Iodoform is incompatible 
with mercuric chloride. 

Physiological Action. — Externally and Locally. — Iodoform or- 
dinarily possesses no irritating action when applied to the skin or 
mucous membranes, or to ulcers and wounds. On the contrary, 
it possesses analgesic properties. It has a tendency to check serous 
oozing when applied to wounds. 

Internally. — Digestive System. — Small doses, if they have any 
effect, slightly increase the appetite, and tend to increase the sali- 
vary, biliary, and intestinal secretions. Large doses disturb the 
stomach, and may occasion nausea, vomiting, and diarrhea. 

Circulatory System. — Small doses retard and strengthen the 
pulse, and, for a brief period only, increase arterial tension. Full 
medicinal doses lessen arterial tension and render the pulse slower 
and weaker. Lethal doses rapidly accelerate the pulse, causing it 
to become irregular ; later, the action of the heart is slowed, and 
finally arrested in diastole, from paralysis of the cardiac muscle. 

Nervous System. — Large doses are apt to produce headache, 
restlessness, delirium, or stupor. The reflexes may be depressed, 
or in some cases choreic movements may appear. Muscular con- 
tractility and the excitability of the nerve-centers to external stimu- 
lation are lessened. 

Respiratory System. — Very large doses produce convulsive res- 
piratory movements. 

Absorption and Eliminatio?t. — Iodoform is absorbed from the 
stomach, or from mucous membranes or wounds to which it is 
applied. It is slowly absorbed from the alimentary canal, but readily 
absorbed from wounds. In the tissues it combines with the proteid 
molecules, and is retained in the system as potassium iodide and 
other iodides. It is eliminated in all the secretions, and has been 
detected in the urine and saliva within one hour after its administra- 
tion, traces of it being perceptible in the secretions for three days. 
Iodine is liberated at the points of elimination, either as an iodate or as 
some organic compound of iodine, or both. The drug is also detected 



ANTISEPTICS. 351 

in the breath, though it is chiefly eliminated in the urine as alkaline 
sodium iodate, coloring the urine yellow. It should be remembered 
that iodoform is absorbed much more rapidly than it is eliminated. 

Temperature. — Large doses cause a rise of temperature, while 
poisonous doses may, at the last, produce a decided reduction of 
animal heat. 

Untoward Action. — Sometimes iodoform excites an eczematous 
eruption, which may be papular or erythematous, and symptoms of 
vertigo. Muscular weakness and double vision have also been 
observed ; sleepiness, alternating with excitement ; incoherence of 
speech ; headache ; mental confusion ; and amblyopia. 

Poisoning. — Three forms of poisoning by iodoform are described 
by Duret — the eruptive, the cerebral, and the syncopal. 

No two cases of poisoning present the same symptoms, hence 
every case should be considered a law unto itself and be treated 
accordingly. With reference to fatal doses, 75 grains (5 Gm.), 
administered over a period of one week, have caused death. 

In the first of these there may be a severe and extensive ery- 
thema or eczematous eruption. The cerebral variety is character- 
ized by rapid increase of temperature and accelerated pulse — as 
high as 150 or 175 per minute; great irritation of the gastrointes- 
tinal tract ; widely dilated, or motionless and contracted, pupils ; 
intense headache over the entire circumference of the head ; mel- 
ancholia ; great depression of spirits ; hallucinations and active 
delirium or suicidal mania. 

In the syncopal variety the patient complains of dizziness and 
mental confusion ; is languid and weak ; the heart's action becomes 
very rapid and feeble, the patient passing at length into a lethargic 
or comatose condition, with paralysis of the sphincters, and finally 
dying, perhaps quite suddenly. 

The symptoms of poisoning may appear soon after the applica- 
tion of the drug, or they may be deferred for days and even weeks. 
In the latter case, which may properly be termed chronic poison- 
ing, the patient is more apt to be melancholy, weak, and apathetic, 
with slight fever and accelerated pulse. Old people are the more 
susceptible to its toxic influence. 

Treatment of Poisoning. — Every particle of the drug should be 
immediately removed from the body or its internal administration 
be discontinued at once. Stimulants, diaphoretics, and diuretics 
should be given, with frequent bathing of the body in warm water, 
to hasten elimination. Opium and large doses of potassium bicar- 
bonate have been recommended. 



352 A TEXT-BOOK OF MATERIA MEDICA. 

Therapeutics. — Externally and Locally. — Iodoform acts as an 
alterative, analgesic, protectant, antiseptic, and germicide to at least 
some forms of bacilli. It is therefore one of the best applications 
to wounds, ulcers, etc. It is especially valuable in the treatment of 
tubercular affections, such as tubercular joints, when it is used in 
the form of an injection — 10 to 20 per cent — in sterilized olive oil. 
In tubercidar parenchymatous synovitis the mixture is injected di- 
rectly into the joint-cavity. Rinonapoli recommends a 10 per 
cent, ethereal solution in malignant pustule, injected hypodermically 
into the base of the tumor ; while Terrier and Mosetig von Moorhof 
have both used it successfully in parenchymatous goiter. 

Iodoform is an exceedingly valuable application to syphilitic 
ulcers, chancres, chancroids, suppurating buboes, ulcerations of the 
uterus, uterine cancer, and indolent and irritable ulcerations of the leg. 

Incorporated in a suppository, it is very efficacious in painful 
hemorrhoids, fistula, and fissure of the anus. 

It is a valuable application in many diseases of the ear, nose, 
throat, eye, and skin where a drug of this character is indicated. 

Internally. — Iodoform is used but very little internally, although 
it has been employed in phthisis, hemoptysis, syphilis, catarrhal 
jaundice, hepatic cirrhosis, gastric catarrh, diabetes, and as an intes- 
tinal antiseptic. 

The allied compounds mentioned above are used locally as sub- 
stitutes for iodoform. Most of them possess the great advantage 
of being odorless, and some of them seem to be in all respects 
quite as efficient as iodoform. Aristol is undoubtedly superior to 
it in the treatment of indolent ulcers and in many diseases of the 
skin, ear, nose, and throat. Europhen and iodol should certainly 
replace iodoform in many cases. 

Administration. — Internally, iodoform should be given in pills 
or capsules. Externally, it may be used in the form of a powder, 
alone or mixed with powdered borax or boric acid. It is also used 
in the form of an ointment or collodion. It is given hypodermi- 
cally, mixed with olive oil and glycerin, or dissolved in ether, in 
strengths varying from 10 to 30 per cent. 

Its disagreeable odor may be modified or disguised by mixing 
it with tar, liquid styrax, balsam of Peru, thymol, coumarin, 
menthol, ground coffee, oil of lavender, bergamot, bitter almond, 
coriander, musk, vanilla, or some similar aromatic and pleasantly 
odorous substance. 



ANTISEPTICS. 353 

Benzolnum— Benzolni— Benzoin. TJ. S. J?. 

Origin. — A balsamic resin obtained from Styrax Benzoin Dry- 
ander, a large tree indigenous in Sumatra and Java, and probably 
also in Cochin China and Siam. 

Description and Properties. — Benzoin exudes from incisions in 
the bark, and upon exposure to the air hardens into lumps con- 
sisting of agglutinated, yellowish-brown tears, which are internally 
milk-white, or in the form of a reddish-brown mass, more or less 
mottled from whitish tears imbedded in it. It is almost wholly 
soluble in 5 parts of moderately warm alcohol and in solutions of 
the fixed alkalies. When heated it gives off fumes of benzoic acid. 
It has an agreeable balsamic odor and a slight aromatic taste. 

Benzoin is of the nature of a balsam, containing from 20 to 24 
per cent, of benzoic acid, resin, and volatile oil. Some varieties 
contain cinnamic acid, which is undesirable, while the benzoin from 
Siam contains vanillin and possesses the odor of vanilla. 

Dose. — Benzoin is never administered in substance. 

Official Preparations. 

Adeps Benzoinatus — Adipis Benzoinati — Benzoinated Lard (2 per cent.). — 
For external use. 

Tinctura Benzolni — Tincturae Benzolni — Tincture of Benzoin. — Dose, 30 
minims to I fluidrachm (2.0-4.0 Cc). 

Tinctura Benzolni Comp6sita — Tincturae Benzolni Comp6sitae — Com- 
pound Tincture of Benzoin. — Benzoin, 12; Aloes, 2; Storax, 8; Tolu, 4; Alcohol, 
74 parts. Dose, \-2 fluidrachms (2.0-8.0 Cc). 

Antagonists and Incompatibles. — The tincture and compound 
tincture are incompatible with aqueous preparations, the benzoins 
and other resins and balsams being precipitated from their alcoholic 
solutions by water. 

Physiological Action.- — The action of benzoin is due to the 
benzoic acid which it contains, and will therefore be considered 
under Benzoic Acid. 

Acidum Benzoicum— Acidi Benzoici— Benzoic Acid. 

U. S. JP. 

Origin. — An organic acid usually obtained from Benzoin by 
sublimation, or prepared artificially, chiefly from Toluol. 

Description and Properties. — White or yellowish-white lus- 
trous scales or friable scales, having a slight characteristic odor 
resembling that of benzoin, and of a warm, acid taste ; somewhat 
volatile at a moderately warm temperature, and rendered darker 

by exposure to light. Soluble when pure in about 500 parts of 
23 



354 A TEXT-BOOK OF MA TERIA MEDICA. 

water, in 2 parts of alcohol at about 15 C. (59 F.), in 15 parts 
of boiling water, and in 1 part of boiling alcohol. It is also soluble 
in 3 parts of ether, 7 parts of chloroform, and readily soluble in 
carbon disulphide, in benzol, and in fixed and volatile oils. Sparingly 
soluble in benzin. 

Benzoic acid has an acid reaction and is inflammable. It should 
be kept in dark amber-colored, well-stoppered bottles and in a cool 
place. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Ammdnii Benzoas— Ammonii Benzoatis— Ammo- 
nium Benzoate. U.S. J?. 

Origin. — Dissolve Benzoic Acid in Water of Ammonia and Dis- 
tilled Water, evaporate, and crystallize. 

Description and Properties. — Thin, white, four-sided laminar 
crystals ; odorless, or having a slight odor of benzoic acid ; a sa- 
line, bitter, afterward slightly acrid taste, and gradually losing am- 
monia on exposure to air. Soluble, at 15 C. (59 F.), in 5 parts 
of water, in 28 parts of alcohol, in 1.2 parts of boiling water, and 
in 7.6 parts of boiling alcohol. The salt is neutral or has a very 
slight reaction upon litmus-paper. It should be kept in well- 
stoppered bottles. 

Dose. — 10-20 grains (0.6-1.2 Gm.). 

LIthii Benzoas— LIthii Benzoatis— Lithium 
Benzoate. TJ. S. T. 

Origin. — Prepared by decomposing Lithium Carbonate with 
Benzoic Acid. 

Description and Properties. — A light white powder, or small, 
shining, crystalline scales ; odorless or of a faint, benzoin-like odor, 
and of a cooling, sweetish taste ; permanent in the air. Soluble in 
4 parts of water, in 12 parts of alcohol, in 2.5 parts of boiling water, 
and in 10 parts of boiling alcohol. The presence of sodium ben- 
zoate increases the solubility in water and lessens it in alcohol. 
The aqueous solution (1 in 20) of lithium benzoate has a faintly 
acid reaction upon litmus. 

Dose. — 5-20 grains (0.3-1.2 Gm.). 

Sodii Benzoas— Sodii Benzoatis— Sodium 
Benzoate. U. S. P. 

Origin. — Prepared by decomposing Sodium Carbonate with 
Benzoic Acid. 



ANTISEPTICS. 355 

Description and Properties. — A white amorphous powder, 
odorless or having a faint odor of benzoin and a sweetish, astrin- 
gent taste. Soluble in 1.8 parts of water, in 45 parts of alcohol, 
in 1.3 parts of boiling water, and in 20 parts of boiling alcohol. 
The aqueous solution is neutral to litmus -paper. It is efflorescent, 
and should be kept in well-stoppered bottles. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Allied and Unofficial Preparations. 

Bismuthi BSnzoas — Bismuthi Benzoatis — Benzoate of Bismuth. 
M6nthol BSnzoas — MSnthol Benzoatis — Benzoate of Menthol. — For exter- 
nal use. 

Other benzoic combinations of interest are : Benzanilid, an antipyretic for children. 
Dose, 1-8 grains (0.1-0.5 Gin.). Benzo-napthol, analogous to betol, intestinal antiseptic 
in doses of 4-8 grains (0.25-0.5 Gm.). Benzosol, aguaiacol benzoate, used as an anti- 
septic and for the same general purposes as guaiacol. Dose, 4-8 grains (0.25-0.5 Gm.). 
Peronin, tropococaine, saccharin, and eucaine-/? are all benzoyl compounds. 



Antagonists and Incompatibles. — Benzoic acid is incompatible 
with the alkaline salts, as those of sodium, etc., and ammonium 
benzoate is incompatible with the ferric salts. 

Physiological Action. — Externally. — When applied in a con- 
centrated form to the skin or mucous membrane benzoic acid is an 
irritant, and produces a catarrhal condition of the bronchial mucous 
membrane when its vapors are inhaled. It is a powerful antiseptic 
and germicide, preventing the growth of putrefactive bacteria in 
a solution of I : 1000. 

Internally. — Digestive System. — In full medicinal doses benzoic 
acid irritates the throat and produces a sense of heat in the epi- 
gastrium. Very large doses may occasion gastric inflammation^, 
with nausea and vomiting. The functional activity of the liver is 
stimulated by sodium benzoate. 

Circulatory System. — In large doses benzoic acid increases the 
pulse-rate to a marked extent, and is a stimulant to the entire 
circulatory apparatus. 

Respiratory System. — It is a powerful stimulant in moderate 
medicinal doses, increasing the respiratory movements and promot- 
ing the bronchial secretion. 

Absorption and Elimination. — It is eliminated chiefly by the 
kidneys, but also by the skin, salivary glands, and broncho-pul- 
monary mucous membrane. 

The important action of benzoic acid is the change it undergoes 
in the kidneys, being converted into hippuric acid, in combination 



356 A TEXT-BOOK OF MATERIA MEDICA. 

with glycocoll. This change takes place only in the kidneys, and 
the hippuric acid formed renders alkaline urine acid, besides in- 
creasing the urinary flow and disinfecting and stimulating the 
genito-urinary tract. 

Temperature. — Like other members of this group, the acid, as 
well as its salts, possesses antipyretic properties, many observers 
holding it to be equal, if not superior, to salicylic acid in this 
respect. It is not yet known in what manner it reduces temper- 
ature. 

Untoward Action. — Benzoic acid sometimes produces urticaria 
or an erythematous condition of the skin. 

Therapeutics. — Externally and Locally. — The compound tinc- 
ture of benzoin is an admirable preparation for many conditions 
requiring antiseptic, astringent, and stimulating dressing. It is fre- 
quently applied to cutaneous wounds, the alcohol evaporating and 
leaving upon the injured parts a protective film of balsams. A 
piece of lint or absorbent cotton saturated with the compound 
tincture has been used to close the punctures in the skin after 
tenotomy. 

Stille recommends a combination of the compound tincture of 
benzoin and glycerin for the treatment of chapped hands and lips, 
frost-bite, and fissured and chapped nipples. 

R. W. Taylor treats " ringworm of the thighs " by painting the 
affected part with a mixture of bichloride of mercury and com- 
pound tincture of benzoin, 2-5 grains to 1 ounce (0.12-03 to 30.0 
Cc). 

The compound tincture, diluted with water in various propor- 
tions, makes an efficient application in catarrhal affections of the 
pharynx and larynx, either in the beginning of an inflammation or 
during the relaxed condition which so often accompanies the ter- 
mination of an acute attack. The hoarseness of vocalists and public 
speakers, the result of excessive strain upon the vocal cords, is 
frequently relieved by this remedy. 

Inhalations of benzoin are a popular and frequently effective 
method of treating acute catarrhal inflammation of the upper 
respiratory passages. 

The cough and expectoration of chronic bronchitis and chronic 
phthisis are eased and lessened by inhaling night and morning a 
drachm (4 Gm.) of benzoic acid, added to boiling water. 

A preparation like the following is an efficient and agreeable 
lotion for irritative forms of chronic nasal catarrh : 



ANTISEPTICS. 2)57 

R. Sodii boratis, ad. ^ij (60.0 Gm.) ; 

Acidi benzoici, gr. x (0.6 Gm.). — M. 

Fiat pulvis No. I. 

Sig. To half a tumblerful of water add hall a teaspoonful each of the powder and 
glycerin. Use freely as a lotion. 

The simple tincture of benzoin is an excellent application to 
spongy gums. There is much evidence of the efficiency of bismuth 
benzoate as a dressing for chronic or sloughing ulcers. Specific 
sores, cha?icroids and chancres especially, are well treated by dust- 
ing the parts with the benzoate after thoroughly bathing the surface 
with a weak solution of bichloride of mercury. 

Probably the most important therapeutic action of benzoic acid 
is shown in the treatment of cystitis and pyelitis accompanied by 
decomposing and alkaline urine. 

The uric-acid diathesis is modified by this drug and its prepara- 
tions, particularly by the lithium benzoate. Phosphatic calculi 
may be dissolved by the prolonged administration of ammonium 
benzoate, which is preferable to benzoic acid for this purpose. In- 
continence of urine, if due simply to the alkalinity of the urine, is 
relieved by the same remedy. 

Liegeois has employed sodium benzoate as a cholagogue with 
excellent results. He associates it with rhubarb. He also states 
that benzoate of sodium favorably modifies the pain of pharyngitis. 
Sodium benzoate is an excellent substitute for sodium salicylate, 
being especially useful in the septic diseases. It is equally power- 
ful as an antiseptic and antipyretic, though slower in its action than 
sodium salicylate. Its effects, however, are more permanent, and 
innocuous. 

Administration. — Benzoic acid is best administered in pill form 
or in capsules, with balsam of fir or Castile soap as an excipient. 
The soluble benzoates may be given in solution in some aromatic 
water or in compressed pills. The solution, however, is preferable, 
and the unpleasant taste may be well disguised by a little spirit of 
chloroform. When any of these preparations are given for their 
action upon the urinary tract, it may sometimes be advantageous 
to combine them with a urinary sedative, such as tincture of bella- 
donna or hyoscyamus. 

Myrrha— My rrhae— Myrrh. TJ. S. J\ 

Origin. — A gum-resin obtained from Commiphora Myrrha 
(Nees) Engler, a shrub or small tree " forming the chief underwood 



35 8 A TEXT-BOOK OF MA TERIA MEDICA. 

of the Arabian and African forests along the shores of the Red 
Sea." 

Description and Properties. — Roundish, irregular tears or 
masses, dusty brownish-yellow or reddish-brown ; fracture waxy, 
somewhat splintery, translucent on the edges, sometimes marked 
with whitish veins ; odor balsamic ; taste aromatic, bitter, and acrid. 
It contains 60 per cent, of gum, 35 per cent, of resin, and 3 or 4 
per cent, of a volatile oil (myrrhol). 

Dose. — 5-30 grains (0.3-2.0 Gm.), in pills or emulsion. 

Official Preparations. 

Mistura FSrri Comptisita — Misturae FSrri CompSsitae — Compound Iron 
Mixture. — Dose, \-2 fluidounces (15-60 Cc). 

Pilulae Aloes et Myrrhae — Pllulas (ace.) Aloes et Myrrhae — Pills of Aloes 
and Myrrh. — Dose, 2 to 5 pills. 

Tinctiira Aloes et Myrrhae — Tinctiirae Aloes et Myrrhae — Tincture of Aloes 
and Myrrh (10 per cent.). — Dose, \-2 fluidrachms (2-8 Cc). 

Tinctiira Myrrhae — Tincturae Myrrhae — Tincture of Myrrh (20 per cent.). — 
Dose, 15-60 minims (1-4 Cc). 

Physiological Action. — Myrrh is astringent, disinfectant, slightly 
antiseptic, and stimulant. Its action resembles that of the aro- 
matics, stimulating the appetite and acting as a carminative, exces- 
sive doses causing nausea and vomiting. It increases the number 
of white blood-corpuscles, and is a stimulant to the circulation. 

The drug is eliminated by the mucous membranes generally, aug- 
menting and disinfecting their secretions. It possesses emmena- 
gogue properties. 

Therapeutics. — As a stimulant and astringent myrrh is service- 
able as a mouth-wash in ptyalism and spongy gums and in ozena. 
It is useful as a gargle in pharyngitis, relaxed throat, etc., and as an 
injection in leucorrhea, the latter disease, as well as cystitis, being 
favorably influenced by the internal administration of the drug. It 
has been used internally, with considerable success, as a stimulant 
expectorant in bronchorrhea and chronic bronchitis, and as a stom- 
achic in atonic dyspepsia. 

Administration. — Myrrh may be given internally in the form 
of an emulsion or pills. The tincture, either in full strength or 
diluted, is chiefly employed externally. 

Balsamum Peruvianum— Balsami Peruviani— Bal- 
sam of Peru. IT. S. I*. 

Origin. — A balsam obtained from Toluifera Pareirce (Royle) 



ANTISEPTICS. 359 

Baillon, a tree growing in Brazil and near the west coast of South 
America. 

Description and Properties. — A liquid having a syrupy con- 
sistence, free from stringency or stickiness, of a brownish-black 
color in bulk, reddish-brown and transparent in thin layers, of an 
agreeable, vanilla-like, somewhat smoky odor, and a bitter taste, 
leaving a persistent after-taste. On exposure to air it does not 
become hard. It is completely soluble in 5 parts of alcohol. 

The drug contains, among other substances, benzoic and cin- 
namic acids, cinnamein about 60 per cent, and resin 32 per cent. 

Dose. — 8-30 minims (0.5-1.84 Cc). 

Physiological Action. — Its properties are similar to those of 
myrrh, its action being almost analogous. 

Therapeutics. — In various cutaneous disorders balsam of Peru 
is very efficient, being employed in pruritus vulva, eczema, scabies, 
ringworm, etc. It is remarkably efficacious as an application to 
cracked nipples, cracked lips, indolent sores, bed-sores, etc., and is 
also serviceable in certain diseased conditions of the nose and 
throat, such as atrophic rhinitis and tonsillar diphtheria. 

As a stimulant expectorant the drug is efficient in chronic bron- 
chitis, being regarded by some physicians as of great service in 
phthisis pulmonalis. Like myrrh, balsam of Peru has been used 
to some extent as a stomachic carminative and tonic. 

Administration. — It is best given in an emulsion or in glycerin. 

Eucalyptus— Eucalypti— Eucalyptus. U. S. JP. 

Origin. — The leaves of Eucalyptus globulus Labillardiere, col- 
lected from the older part of the tree. The blue-gum tree is a rapid 
grower, attaining a height of 200 to 300 feet (60-90 M.). It is 
native to Australia, but is cultivated in various portions of Europe, 
Africa, and the United States with the view of rendering malarial 
districts habitable by its antiseptic exhalations. Its efficacy in this 
direction is due solely to its using large quantities of water for its 
growth, thereby depriving the malarial bearing mosquitoes of the 
marshy grounds in which they develop their larvae. 

Description and Properties. — Petiolate, lanceolate, scythe- 
shaped, from 6 to 12 inches (15-30 Cm.) long, rounded below, 
tapering above, entire, leathery, grayish-green, glandular, feather- 
veined between the midrib and marginal veins ; odor strongly cam- 
phoraceous ; taste pungently aromatic and somewhat cooling, bitter, 
and astringent. 



360 A TEXT-BOOK OF MATERIA MEDICA. 

The most important constituent is a volatile oil, of which the 
leaves yield about 6 per cent. 

Dose. — J-2 drachms (2.0-8.0 Gm.). 

Official Preparation. 

Extractum Eucalypti Fluidum— Extracti Eucalypti Fluidi — Fluid Extract 
of Eucalyptus. — Dose, 5-60 minims (0.3-4.0 Cc). 

Oleum Eucalypti— Olei Eucalypti— Oil of Eucalyp- 
tus. U. S. JP. 

Origin. — A volatile oil distilled from the fresh leaves of Euca- 
lyptus globulus Labillardiere, E. oleosa F. v. Muller, and some 
other species of the genus. 

Description and Properties. — A colorless or faintly yellowish 
liquid, having a characteristic, aromatic, somewhat camphoraceous 
odor, and a pungent, spicy, and cooling taste. Soluble in all 
proportions in alcohol. This oil consists of two hydrocarbons 
(cymene and eucalyptene), terpene, and a substance upon which its 
medicinal value depends — eucalyptol. Oil of eucalyptus should be 
kept in well-stoppered bottles, in a cool place, protected from 
light. 

Dose. — 5-15 minims (0.3-1.0 Cc). 

Eucalyptol— Eucalyptol— Eucalyptol. U. S. i>. 

Origin. — A neutral body obtained from the volatile oil of 
Eucalyptus globulus. 

Description and Properties. — A colorless liquid, having a cha- 
racteristic, aromatic, and distinctly camphoraceous odor, and a pun- 
gent, spicy, and cooling taste. Soluble in all proportions in alcohol. 

Dose. — 5-10 minims (0.3-0.6 Cc). 

Unofficial Preparations. 

Aqua Eucalypti — Aquae Eucalypti — Eucalyptus Water. — Dose, 2-4 fluid- 
drachms (7.39-15.0 Cc). 

Tinctura Eucalypti — Tincturae Eucalypti — Tincture of Eucalyptus. — Dose, 
1-4 fluidrachms (3.7-15.0 Cc). 

Antagonists and Incompatibles. — Agents promoting waste an- 
tagonize the therapeutic action of eucalyptus. The chemical incom- 
patibles are the mineral acids, mineral salts, and alkalies. 

Synergists. — The vegetable bitters, aromatics, antispasmodics, 
turpentine, cubebs, and copaiba. 



ANTISEPTICS. 361 

Physiological Action. — Externally and Locally. — Locally ap- 
plied, the oil of eucalyptus and eucalyptol are more or less irritant, 
though perhaps less active than many volatile oils. In contact with 
mucous membranes or injected hypodermically, they cause pain, 
and, when swallowed, produce a burning sensation in the throat, 
stomach, and intestines. 

If the vapor of eucalyptus be confined by preventing evapora- 
tion, vesication and pustulation result, the drug also acting as a 
rubefacient. Inhalation affects the bronchial mucous membrane 
unfavorably, the beneficial effects of the remedy residing in its 
properties as a powerful antiseptic and disinfectant. It is also 
slightly detergent and astringent. 

Internally. — Digestive System. — Small doses, by stimulating the 
salivary and peptic glands, improve the appetite and digestion, 
while peristalsis is increased, the drug acting as a mild laxative. 
The ingestion of large amounts may occasion anorexia, nausea, 
vomiting, and perhaps diarrhea, although the drug cannot be con- 
sidered an active emetic nor does it possess marked purgative 
properties. 

Circulatory System. — Like quinine, eucalyptus arrests the ame- 
boid movements of the white blood-corpuscles. It resembles that 
drug also in its reputed property of contracting the enlarged spleen. 
Medicinal doses of eucalyptol stimulate the heart, increasing the 
blood-pressure — probably the effect of reflex action from the stom- 
ach. The arterial tension, however, though at first raised, is sub- 
sequently reduced, the pulse, which under moderate amounts of 
the drug shows an increase in force and frequency, being lowered 
by immoderate dosage. 

Nervous System. — Small doses stimulate mental activity. Fre- 
quent accompaniments of large doses are insomnia in the healthy 
and somnolence in debilitated subjects, and under certain condi- 
tions cerebral congestion, owing to the increased quantity of blood 
sent to the brain. Large or toxic doses are powerfully depressant 
to the brain, medulla, and spinal cord, abolishing the reflexes and 
at times occasioning loss of sensation in the lower limbs. 

Respiratory System. — The drug tends to accelerate the respira- 
tory movements under small or moderate dosage ; poisonous doses 
retard the breathing, finally arresting it, and causing death by 
paralysis of respiration. 

Absorption and Elimination. — The drug acting as a marked diu- 
retic, it is natural that elimination should take place largely by the 



362 A TEXT-BOOK OF MA TERIA MEDICA. 

kidneys. The skin, bowels, and bronchial mucous membrane share 
in the excretory process, the drug acting as a stimulant to the 
structures by which elimination takes place. A characteristic odor 
— resembling that of violets — is imparted to the urine, breath, and 
discharges from the bowels. Renal congestion, with pain in the 
region of the kidneys, is occasionally produced by very large doses 
of the drug. 

Temperature. — Excessive doses result in a fall of temperature. 
According to Schlager, a thermal rise succeeds the hypodermic 
injection of the drug, due probably to local irritation. 

Poisoning. — While fatal results from the ingestion of large doses 
are recorded, the toxic effects of eucalyptus are practically confined 
to the lower forms of animal and vegetable life — infusoria, crypto- 
gamia, etc. In Gimbert's experiments upon animals it was noted 
that the heart continued to beat for some time after respiration had 
ceased ; from which it may be concluded that, since the motor 
nerves and muscles retained their functional activity after death, 
failure of mobility and reflex power is due to central action, the 
drug in toxic doses being a paralyzant to the spinal cord and the 
medulla. 

Drowsiness, shallow breathing, cardiac weakness, and reduced 
arterial pressure are common results of poisonous doses of euca- 
lyptus. 

Treatment of Poisoning. — The stomach should be emptied, and 
the treatment should include the administration of alkalies or some 
preparation of iron, eliminants, strychnine, coffee, and diffusive 
stimulants. 

Therapeutics. — Eucalyptus is a valuable remedy in chronic 
inflammation of mucous membranes, especially in atrophic rhinitis, 
where it is best applied in spray combined with a liquor petroleum 
excipient in the proportion of 30-60 min. (2-4 cc. to the ounce — 
33 Gm.). 

It has proved of service in acute and chronic skin diseases, 
notably simple dermatitis, and in chronic forms of eczema and 
psoriasis. As others of the turpentine series, it is a stimulant to 
sluggish ulcers. It is also serviceable as a gastro-intestinal dis- 
infectant, and is highly recommended by Lydston in typhoid 
fever. 

At one time eucalyptus enjoyed wide repute as a malarial 
specific, but it is certainly far less efficacious than quinine, and in 
the acute paroxysms it is probably of but secondary importance. 



ANTISEPTICS. 363 

The chief value of this drug lies perhaps in its effects upon the 
urine in its elimination. It is an active antiseptic and is useful in 
cystitis and pyelitis. 

As a stimulant expectorant eucalyptus is of great value, equal- 
ling, if not being superior to, any other remedy in bronchorrhea, 
pulmonary gangrene, and fetid bronchitis, associated or not with 
phthisis. Chronic or catarrhal conditions of the lungs and bronchi 
only are benefited by eucalyptus, acute affections of the broncho- 
pulmonary mucous membrane contraindicating its use. A solution 
of oil of eucalyptus is used as an antiseptic inhalation in diphtheria. 

Administration. — The fresh leaves may be employed as poul- 
tices. Any of the preparations may be used, but for internal pur- 
poses the oil, or eucalyptol, is preferable, although a good fluid 
extract is an agreeable form of the medicine. The oil, or euca- 
lyptol, may be given in an emulsion or in capsules, for topical use 
being diluted with alcohol or oil or incorporated in suppositories or 
ointments. 

Sodii Boras— Sodii Boratis— Sodium Borate. 

U. S. J>. 

(Borax.) 

Origin. — Prepared by boiling together solutions of Boric Acid 
and Sodium Carbonate, the borax crystallizing out. It is also found 
in a native state on the shores of certain lakes and as a crystalline 
deposit in the Borax Lake of California. 

Description and Properties. — Colorless, transparent, mono- 
clinic prisms, or a white powder, inodorous, and of a sweetish, 
alkaline taste ; slightly efflorescent in warm, dry air ; soluble in 16 
parts of water and in I part of glycerin ; insoluble in alcohol. 

Dose. — 5-30 grains (0.32-2.0 Gm.). 

Acidum Boricum— Acidi Borici— Boric Acid. U. S. jP. 

(Boracic Acid.) 

Origin. — Found native in Northern Tuscany. It may be pre- 
pared by the action of Hydrochloric Acid on Borax, filtration, and 
recrystallization. 

Description and Properties. — Transparent, colorless scales, of 
a somewhat pearly luster, or, when in perfect crystals, six-sided, 
triclinic plates, slightly unctuous to the touch, odorless, of a faintly 



364 A TEXT-BOOK OF MA TERIA MEDICA. 

bitterish taste, permanent in the air. Soluble in 25.6 parts of 
water, 15 parts of alcohol, and 10 parts of glycerin. The addition 
of hydrochloric acid increases its solubility in water. 
Dose. — 5-15 grains (0.32-1.0 Gm.). 

Official Preparation. 

Glyceritum Boroglycerini — Glyceriti Boroglycerini— Glycerite of Boro- 
glycerin (Glycerite of Glyceryl Borate — Solution of Boroglyceride).— 
Boric Acid, 310; Glycerin, to 1000. For external use. 



Antagonists and Incompatibles. — The incompatibles of borax 
are the acids and metallic salts. Morphine and cocaine are pre- 
cipitated from solution by borax. Boric acid is also incompatible 
with the carbonates and bicarbonates, and with the alkaline, earthy, 
and metallic bases. 

Synergists. — The action of borax is enhanced by alkalies and 
substances promoting waste; that of boric acid, by the anti- 
septics. 

Physiological Action. — Externally and Locally. — Borax is ab- 
sorbent, protectant, sedative, and antiseptic. Applied to the un- 
broken skin, it acts upon the epidermis as a soap. By removing 
the stimulus to secretion and lessening irritation borax checks the 
secretion of the salivary glands. 

Boric acid possesses properties similar to those of borax, 
although more of an antiseptic and antipruritic. It has also an 
exsiccant and detergent influence. 

Internally. — In a general way the action of borax is analogous 
to that of the alkalies. It is refrigerant and diuretic, and by its 
immediate action upon the womb serves as an emmenagogue, large 
doses contracting the uterine muscles and acting as an ecbolic. 
Excessive doses of either of these drugs act as gastro-intestinal 
irritants. 

Boric acid, though stronger, resembles borax in its action. Both 
substances, especially boric acid, retard the action of saliva upon 
starch, increasing that of the pancreatic juice upon albuminous 
substances, and increase gastric digestion. Immoderate doses of 
boric acid check gastric digestion. 

The drug is a moderate antipyretic, and when injected in large 
amounts into the circulation may occasion paralysis of the motor 
nerves and muscles. 

Absorption and Elimination. — It is eliminated by the saliva, per- 



ANTISEPTICS. 365 

spiration, feces, and urine, the latter being increased in quantity. 
The amount of nitrogen and solid matter excreted with the feces 
is also increased, as well as the elimination of urea in the urine. 

Untoward Action. — Boric acid has occasioned the following 
untoward symptoms : frequent desire to micturate ; nausea, vom- 
iting, and other gastric disturbances ; small, weak pulse ; derange- 
ment of the nervous system ; hiccough ; and various cutaneous 
eruptions. 

Poisoning. — The symptoms of poisoning are analogus to those 
described above. 

Treatment of Poisoning. — The treatment of poisoning should 
be symptomatic, stimulants, morphine, etc. being employed. 

Therapeutics. — Externally and Locally. — Both of the above 
drugs are exceedingly valuable as local remedies in the treatment 
of many disorders of the ear, nose, and throat, such as acute and 
chronic nasal catarrh, pharyngitis, gingivitis, and acute hoarseness. 

An efficient domestic remedy in aphtha affecting the mouths of 
nursing children is a mixture of borax and honey. 

An invaluable aseptic application in acute conjunctivitis is a sat- 
urated solution of boric acid, and the dry powder serves as an 
efficient remedy in otorrhea. 

Leucorrhea, gonorrhea, and chronic cystitis are greatly benefited 
by solutions, in various strengths, of either or both of these drugs. 
Sir James Simpson recommends a solution of borax, 5-10 grains 
(0.32-0.6 Gm.) to I ounce (30.0 Cc.) of hot water, for the eruption 
occurring on the mucous membrane of the vulva in young girls. 

Since the introduction of boric acid as an antiseptic by Lister in 
1872 it has steadily grown in favor in this respect, being univer- 
sally employed to-day, both in solution and in the powdered form, 
for the numerous conditions requiring an agent of this character. 
It is invaluable as a bland, unirritating antiseptic in general surgery, 
and in diseases of the eye, ear, nose, throat, and skin. 

It is perhaps unnecessary to enumerate the multifarious and 
efficient uses of this drug, the practising physician readily recog- 
nizing the conditions in which this potent remedy may be advan- 
tageously employed. 

It should be borne in mind, however, that the antibacterial 
action of these compounds is very slight and only concentrated 
solutions are of any avail. In otitis media it can be used in alco- 
holic solution, the evaporation of the alcohol leaving the pure sub- 
stance behind. 



366 A TEXT-BOOK OF MA TERIA MEDICA. 

Internally. — Borax is used internally more than boric acid. 
While in epilepsy inferior to the bromides, there are cases un- 
influenced by the latter remedies which respond favorably to 
borax. 

Its value in epilepsy is very questionable unless one ascribes it 
to its antibacterial action in the intestines, thus limiting putrefactive 
processes in this viscus. 

In otitis media it is widely employed and is of distinct service. 

The author has favorably influenced the character of the urine 
in chronic cystitis by 5-grain (0.3 Gm.) doses of boric acid three 
times a day. 

These drugs have been used internally in the summer diarrhea 
of children. 

Administration. — The remedies may be given in capsules or 
solution. The taste of borax may be disguised by coffee, syrup of 
orange, or aromatic elixir of liquorice, the drug not being admin- 
istered with glycerin, lest an acid reaction occur. 

Potassii Permanganas— Potassii Permanganatis— 
Potassium Permanganate. U. S. P. 

Origin. — Obtained by heating together Caustic Potash, Potas- 
sium Chlorate, and Manganese Dioxide. The potassium manga- 
nate formed is converted into the permanganate by boiling it in 
water. 

Description and Properties. — Slender, monoclinic prisms, of 
a dark-purple color, almost opaque by transmitted light, and of a 
blue, metallic luster by reflected light ; odorless, with at first a sweet 
and afterward a disagreeable and astringent taste ; permanent in the 
air; soluble in 16 parts of water. In contact with alcohol it is 
decomposed. 

Potassium permanganate should be kept in glass-stoppered bot- 
tles, protected from light, and should not be brought in contact 
with organic or readily oxidizable substances. 

Dose. — 1-2 grains (0.03-0. 1 2 Gm.), as a pill. 

Antagonists and Incompatibles. — Organic matter easily deox- 
idizes it, causing an explosion. 

Synergists. — Theoretically, the antiseptics would enhance its 
antiseptic action. 

Physiological Action. — Potassium permanganate is employed 
as an antiseptic and oxidizing agent in certain diseases, both the 






ANTISEPTICS. 367 

internal and external use of the drug having proved beneficial. 
The peculiar property of the remedy is its readiness to part with 
oxygen, and its consequent availability as an agent in the destruc- 
tion of deleterious organisms. Brunton asserts that " when mixed 
with cobra-poison it completely destroys the deadly power of the 
latter, and the mixture may be injected subcutaneously without 
any bad effect," though he adds that as an antidote it is unservice- 
able, since it does not come in contact with the venom in the tissues. 

In rare instances, it is asserted, potassium permanganate has 
occasioned a vesicular eruption not unlike eczema. It is at times 
decidedly caustic. 

Therapeutics. — Externally and Locally. — In concentrated solu- 
tions or in substance it is a mild escharotic. Its readiness to part 
with ogygen renders it of great value as a deodorant, and in dilute 
solutions, I to 5 grains (0.06 to 0.32 Gm.) to 1 ounce (30 Cc.) of 
water, it is a useful application to foul ulcers, cancer of the uterus, 
vagina, etc. A solution of this drug is employed for various pur- 
poses as an antiseptic, germicide, and deodorant, in the treatment 
of gonorrhea, leucorrhea, diphtheria, putrid sore throat, ozena, naso- 
pharyngeal catarrh, cancer of the tongue, and syphiltic ulcers. 

A weak solution of potassium permanganate is an efficient ap- 
plication in bromidrosis , and a 1 : 2000 or 1 : 5000 solution is recom- 
mended by Dr. Terson in purulent ophthalmia. Potassium per- 
manganate should not be used as an antiseptic in the peritoneal 
cavity, on account of its irritating properties. It is employed 
extensively in surgical practice for washing the hands and utensils. 

Internally. — Like iron, potassium permanganate has been em- 
ployed in anemia, although far inferior to the former drug. Favor- 
able reports are given regarding its value in gastric fermentation 
and lithiasis. 

Dr. Moor of New York recently advocated its use as an anti- 
dote to morphiiie-poisoning. It seems to form a chemical substance 
with morphine which is circulating in the blood, rendering the lat- 
ter inert. The drug has, therefore, been considered by some author- 
ities a true physiological antagonist in morphine-poisoning, whether 
administered hypodermically or by the mouth. Other authorities 
claim that it is but a chemical antagonist for morphine, being active 
only when brought in actual contact with the poison. 

Dr. Moor claims, however, that potassium permanganate does 
not possess the same antidotal power over certain other alkaloids, 
such as strychnine, atropine, cocaine, aconitine, etc. Antal, on the 



368 A TEXT-BOOK OF MATERIA MEDIC A. 

other hand, maintains that the drug is equally serviceable in mor- 
phine- and strychnine-, as well as muscarine-, poisoning, and in that 
resulting from toxic doses of colchicum and oxalic acid. Dr. Koosa 
believes it to be also efficient in poisoning from hydrocyanic acid, 
and Dr. Hognos reports very favorably as to its antidotal power in 
poisoning from phosphorus, having treated two cases successfully 
with this remedy. 

Recently, Dr. Fr. Lanz reports interesting statistics of Prof, 
von Jaksch's clinic in which phosphorus-poisoning was treated 
with douches of potassium permanganate, the death-rate, however 
— 36.66 per cent. — not speaking very favorably for the antidotal 
power of the drug in connection with phosphorus. 

Administration. — For internal use potassium permanganate 
should always be given in pill form, kaolin being used as an 
excipient, lest an explosion occur. 

Potassii Bichromas— Potassii Bichromatis— Potas- 
sium Bichromate. U.S.JP. 

Origin. — Prepared by roasting in a reverberatory furnace Potas- 
sium Carbonate and Chrome-iron Ore, with the addition of Lime 
or Chalk to prevent fusion. The potassium bichromate formed is 
separated by crystallization from its solution in water acidulated 
with sulphuric acid. 

Description and Properties. — Large orange-red, transparent 
triclinic prisms or four-sided tables, odorless, and having a bitter, 
metallic taste. Permanent in the air; soluble in 10 parts of water; 
insoluble in alcohol. 

Dose. — r J- r - 1 grain (0.0006-0.06 Gm.). 

Antagonists and Incompatibles. — Potassium bichromate is in- 
compatible with soluble salts of silver, mercury, and lead, and 
with liquor potassae, liquor sodae, and ammonia water. 

Synergists. — Agents promoting waste, antiseptics, and caustics. 

Physiological Action. — Externally and Locally. — In substance 
potassium bichromate is an irritant caustic, and, according to 
Miquel, an antiseptic in the proportion of I to 909. 

Internally. — Its action is nearly identical with that of potassium 
chlorate, with the additional properties of an expectorant, emetic, 
and mild alterative. 

Poisoning and treatmeiit of poisoning do not differ essentially 
from those of potassium chlorate. 

Therapeutics. — Externally and Locally. — Potassium bichromate 



. ANTISEPTICS. 369 

is used as a caustic for warts, corns, chancres, chancroids, mucous 
patches, etc., and is also of considerable value as a gargle in 
pharyngitis. 

Internally. — Frazer has recently recommended this drug in the 
treatment of dyspepsia and gastric ulcer, claiming that the pain, 
nausea, vomiting, and tenderness may be readily allayed by doses 
of ^ to \ grain (0.005-0.01 Gm.), taken upon an empty stomach 
three times a day. In acute gastric ulcer he has perceived no 
benefit so far as its effect upon the hemorrhage is concerned, the 
most desirable action of the drug in the latter condition being 
derived from its antiseptic and analgesic influence. 

The author desires to recommend favorably potassium bi- 
chromate, in doses of y^- grain (0.0006 Gm.) every hour or two, in 
aphonia and hoarseness due to excessive action of the vocal cords 
or resulting from an acute cold. He has found this method of 
treatment peculiarly and speedily efficacious. 

Potassii Chloras— Potassii Chloratis— Potassium 
Chlorate. U. S. JP. 

Origin. — Prepared by passing Chlorine into a mixture of Potas- 
sium Carbonate and Slaked Lime. By subsequent boiling in 
water the chlorate separates by crystallization. 

Description and Properties. — Colorless, lustrous, monoclinic 
prisms or plates, or a white powder, odorless, and having a cool- 
ing, saline taste; permanent in the air; soluble in 16.7 parts of 
water ; insoluble in absolute alcohol. Potassium chlorate should be 
kept in glass-stoppered bottles. Great caution should be observed 
in handling the salt, since dangerous explosions are liable to occur 
when it is mixed with organic matters — cork, tannic acid, sugar, 
etc, — or with sulphur, antimony sulphide, phosphorus, or other 
easily oxidizable substance, or upon being either heated directly or 
subjected to trituration or concussion. 

Dose. — 3-20 grains (0.2-1.3 Gm.). 

Official Preparation. 

Trochlsci Potassii Chloratis — Trochiscos (ace.) Potassii Chloratis — 
Troches of Potassium Chlorate. — Each troche contains 5 grains (0.32 Gm). 
Dose, 1 to 4 troches. 

Antagonists and Incompatibles. — In addition to those sub- 
stances mentioned above with which potassium chlorate forms 

24 



370 A TEXT-BOOK OF MATERIA MEDICA. 

explosive compounds, mixture with glycerin and the hypophos- 
phites is liable to produce similar dangerous results. 

Synergists. — Agents promoting waste increase the activity of 
the drug. 

Physiological Action. — Externally and Locally. — It is slightly 
detergent and stimulant, antiseptic and astringent, being irritant 
when applied in concentrated solution to ulcerated surfaces. 

Internally. — Digestive System. — Medicinal doses have no effect ; 
poisonous doses excite violent gastro-intestinal irritation, nausea, 
bloody vomiting, diarrhea, and jaundice. 

Circulatory System. — Small doses of potassium chlorate tend 
to depress and subsequently raise arterial tension, accelerating the 
pulse ; large doses lower arterial pressure alarmingly ; toxic doses 
convert the hemoglobin of the blood into methemoglobin, the dis- 
organized fluid appearing in the urine. Post-mortem lesions are — 
enlargement of the liver, spleen, and kidneys, with evidences of 
marked inflammation over the whole intestinal tract. 

Nervous System. — Medicinal doses are inert. Toxic doses may 
produce delirium and death, preceded by coma or convulsions. 

Respiratory System. — Large doses act as a depressant to the 
respiratory apparatus. 

Absorption and Elimination. — The drug is absorbed with con- 
siderable rapidity, being chiefly eliminated by the salivary glands 
unchanged. The drug does not increase the urinary flow, large 
doses, on the contrary, tending to suppress it. 

Temperature. — Unaffected by medicinal doses, but lowered by 
toxic amounts. 

Untoward Action. — Small doses of potassium chlorate seldom 
produce untoward symptoms, although in rare instances eruptions 
of an erythematous, papular, or vesicular nature have followed the 
use of the drug. Digestive disturbances occasionally ensue, as 
well as pain in the region of the kidneys and albuminuria. 

Poisoning. — In the few recorded cases of poisoning there were 
observed a continuous sensation of choking, excessive thirst, per- 
sistent vomiting, pain in the abdomen and renal tract, and violent 
hiccough. Accompanying symptoms were — a small and rapid 
pulse and faintness, while the urine was albuminous and diminished 
in quantity ; epistaxis was present ; the eyes and lips were cyanotic, 
and the skin slightly jaundiced and markedly anemic; the liver and 
spleen were slightly enlarged ; and there were alternating sensations 
of cold and heat, with drowsiness ending in coma and death. 



ANTISEPTICS. 371 

Treatment of Poisoning. — The stomach should be emptied as 
quickly as possible and demulcents administered. The patient 
should be treated symptomatically, and it may be advisable to 
practice venesection, followed by transfusion of blood, as suggested 
by Landerer. 

Therapeutics. — Externally and Locally. — A solution of this 
drug has been applied with some success in foul ulcers and moist 
eczema. Like the potassium permanganate, it has been employed 
in various diseases of the nose and throat, and is especially service- 
able in ptyalism and aphthous ulceration. As a remedy for syphilitic 
mucous patches and herpes of the buccal cavity it is of considerable 
value. It is more efficient in acute than in chronic pharyngitis. 

It possesses marked cicatrizing power, advantage of which 
property has been taken in the treatment of phagedenic sores, the 
powdered drug being used for this purpose. It is thought that ene- 
mas of potassium chlorate solution favor the healing of rectal ulcers. 

Internally. — As a remedial agent this drug has not met with the 
success prophesied by many physicians. Dr. Coghill of England 
is one of its most enthusiastic champions, the drug having proved 
in his hands highly efficient in improving the quality of the blood 
in such cases as simple anemia, chlorosis, etc., as well as in "pul- 
monary insufficiency" and "deficient oxygenation of the blood." 
Other physicians have recommended it as a valuable galactagogue, 
tonic, and alterative, and as beneficial in certain chronic diseases of 
the skin, scrofula, etc. It has found some advocates as a genito- 
urinary antiseptic and as a remedy in typhoid fever. 

Yet, notwithstanding the extravagant, though isolated, reports 
concerning the great value of the drug, its utility has not been 
universally recognized ; indeed, so good an authority as Marchand 
declares that " chlorate of potassium should be entirely rejected in 
practice, and particularly in the treatment of children." 

Administration. — It may be given in the form of troches, 
powder, tablets, or a solution, an agreeable means of administra- 
tion being in aerated water. Owing to its tendency to decomposi- 
tion when combined with other substances, the drug should be 
prescribed alone. 

Aqua Hydrogenii Dioxidi— Aquae Hydrogenii Diox- 
idi— Solution of Hydrogen Dioxide. TJ. S. P. 

Origin. — A slightly acid, aqueous solution of hydrogen diox- 
ide, containing, when freshly prepared, about 3 per cent, by weight 



372 A TEXT-BOOK OF MATERIA MEDICA. 

of the pure dioxide, corresponding to about 10 volumes of avail- 
able oxygen. 

Description and Properties. — A colorless liquid, without odor, 
slightly acidulous to the taste, and producing a peculiar sensation 
and a soapy froth in the mouth ; liable to deteriorate with age or 
by exposure to heat or protracted agitation. 

Dose. — 1-4 fluidrachms (3.7-15.0 Cc), well diluted with water. 

Physiological Action. — Externally and Locally. — The principal 
action of this preparation seems to be its property of imparting 
oxygen to all oxidizable substances, it being one of the most pow- 
erful oxidizing agents in Materia Medica, and therefore an exceed- 
ingly active non-toxic antiseptic. 

When applied to a suppurating surface, or when mixed with 
mucus, cerumen, or blood, active effervescence is produced. Hy- 
drogen dioxide is a useful detergent and bleaching agent, being 
employed largely for the purpose of bleaching hair and delicate 
fabrics. 

Internally. — It is asserted that hydrogen dioxide yields oxygen 
to the blood, slightly stimulates the nervous system, and acts as a 
diuretic. 

Therapeutics. — Externally and Locally. — Hydrogen dioxide is 
extensively employed to cleanse diseased surfaces, such as ulcers, 
buboes, fistulous tracts, etc. It has been highly recommended as an 
antiseptic in abdominal surgery. As an antiseptic wash in empyema, 
cystitis, joint-cavities, venereal sores, puerperal septic endometritis, etc. 
hydrogen dioxide is an exceedingly valuable agent. 

Hydrogen dioxide appears to be an efficient injection in gonor- 
rhea, and is much used as an antiseptic in many diseases of the 
eye, ear, nose, and throat. It has been highly recommended as a 
solvent for diphtheritic membrane, although when frequently applied 
to the throat it causes an unpleasant sensation of dryness, and it 
seems to prevent the exfoliation of the membrane when the patient 
is treated with antitoxine. 

Hydrogen dioxide serves a useful purpose in disinfecting drink- 
ing-water when suspected of pollution, 1 part sufficing for 1000 
parts of water, in which amount the taste or other potable quali- 
ties of the water are in no way impaired. 

Internally. — While hydrogen dioxide has been recommended 
in epilepsy, diabetes, angina pectoris, pneumonia, asthma, and dyspnea 
due to deficient circulation of blood through the heart and lungs, 
the results following the internal administration in these diseases 



ANTISEPTICS. 373 

have not warranted classing the drug among important internal 
medicines. 

Administration. — For external and local use the drug may be 
gargled, sprayed, or applied with a syringe or a swab, either in full 
strength or diluted with water. Whether for external or internal 
use, the solution should be freshly prepared ; when given internally 
it should be taken from a porcelain or china, not a metal, cup or 
spoon. 

Acidum Sulphurosum— Acidi Sulphurosi— Sulphur- 
ous Acid. U. S. JP. 

Origin. — A liquid composed of not less than 6.4 per cent, by 
weight of Sulphurous Acid Gas (Sulphur Dioxide) and not more 
than 93.6 per cent, of Water. 

Description and Properties. — A colorless liquid, of the cha- 
racteristic odor of burning sulphur, and of a very acrid, sulphur- 
ous taste. It should be kept in dark-colored, glass-stoppered 
bottles, in a cool place, and protected from light. 

Dose. — \-2 fluidrachms (1.8-7.39 Cc). 

Physiological Action. — Externally and Locally. — Sulphurous 
acid is a powerful deoxidizing agent, the fumes of burning sulphur 
having been employed centuries ago to disinfect temples, dwellings, 
etc. It easily abstracts oxygen from organic bodies, the acid, in 
short, being a powerful disinfectant, antiseptic, deodorant, and 
parasiticide. 

Internally. — The disinfecting properties of sulphurous acid are 
less apparent when the drug is ingested than when it is used 
externally. 

Therapeutics. — Externally and Locally. — As an antiseptic, dis- 
infectant, and deodorant sulphurous acid may be employed in the 
treatment of various parasitic skin diseases, and a solution of sul- 
phurous acid affords an efficient application to the throat in pharyn- 
gitis, particularly the gangrenous form, diphtheria, etc. 

According to Dujardin-Beaumetz, Sollaud, and Balbaud, non- 
febrile pulmonary phthisis is often favorably influenced by the daily 
inhalation for a short time of sulphurous-acid vapor. This dis- 
agreeable, not to say dangerous, method of treatment has neither 
been generally adopted nor proved to be of established efficacy. 

The acid is a useful antiseptic to apply to recent wounds, and 
may be employed to disinfect the dejections of the sick, the fumes 



376 A TEXT-BOOK OF MATERIA MEDICA. 

Therapeutics.— Externally and Locally. — Chlorine water is still 
occasionally used "as an antiseptic and deodorant in gangrenous or 
sloughing wounds and for disinfecting foul discharges, etc. It has 
proved beneficial as a local application in aphthous stomatitis, diph- 
theria, and parasitic skin diseases. 

Internally. — Wilcox recommends it highly in the treatment of 
typhoid fever. 

Administration. — When given internally the drug should be 
well diluted. Should poisoning ensue from the ingestion of exces- 
sive amounts, albumen is the best antidote; for the irritation occa- 
sioned by the inhalation of chlorine gas steam-inhalations are 
indicated. 

Calx Chlorata—Calcis Chloratae— Chlorinated Lime. 

U. S. JP. 

("Chloride of Lime.") 

Origin. — A compound resulting from the action of Chlorine 
upon Calcium Hydrate, and containing not less than 35 per cent, 
of available Chlorine. 

Description and Properties. — A white or grayish-white, granu- 
lar powder, exhaling the odor of hypochlorous acid ; of a repulsive 
saline taste, and becoming moist and gradually decomposing on 
exposure to air. It is but partially soluble in water or alcohol. 
The drug should be kept in well-closed vessels, in a cool and dry 
place. Used externally. 

Physiological Action and Therapeutics. — Chlorinated lime is 
a powerful disinfectant, yielding, when exposed to air, hypochlorous 
acid, which is resolved into chlorine and chloric acid, the last in 
turn yielding chlorine. 

The effects of the drug are therefore analogous to those of 
chlorine, yet almost the only use which chlorinated lime serves is 
in disinfecting cesspools and utensils employed for the dejections 
of invalids. 

Liquor S5dae Chloratae— Liquoris Sodae Chloratae— 
Solution of Chlorinated Soda. U. S. r. 

(Labarraque's Solution.) 

Origin. — An aqueous solution of several chlorine compounds 
of Sodium, containing at least 2.6 per cent, by weight of available 
chlorine. 



AROMATICS. tfy 

Description and Properties. — A clear, pale-greenish liquid, 
having a faint odor of chlorine and a disagreeable alkaline taste. 
It should be kept in well-stoppered bottles, protected from light. 
Used externally. 

Physiological Action. — The action of the drug resembles that 
of aqua chlori, although it is feebler than the latter. 

Therapeutics. — Solution of chlorinated soda is used as a disin- 
fectant for fetid ulcers, gangrenous sores, and ozena, and as a disin- 
fectant wash in diseases of the uterus, vagina, and auditory canal. 

Administration. — There are no special directions to be ob- 
served in the application of this solution. 



AROMATICS. 

The following-named drugs, classed by some authors as aro- 
matics, are not only active antiseptics and antispasmodics, but 
possess properties very similar to those of the more typical anti- 
septics, antipyretics, and anesthetics. These antiseptic properties 
of aromatic drugs are well known to modern science, and, what is 
of unique interest and significance, were perfectly familiar to the 
ancients, who could not possibly divine the scientific value of the 
virtues familiarized only by the crudest empiricism. In the custom 
of the Egyptians of embalming the dead we have a remarkable 
example of their divination of antisepsis in the perfumes and spices 
in which their dead were buried ; and in the Christian Gospel we 
read of Nicodemus that he " brought a mixture of myrrh and 
aloes," and that they " took the body of Jesus, and wound it in 
linen cloths with the spices, as the manner of the Jews is to bury " 
(John xix. 39, 40). 

Apart, however, from the remarkable testimony of the fore- 
going examples, these peculiar properties of aromatic herbs appear 
to have been established in all succeeding ages. Especially among 
the Greeks were the medicinal virtues of certain aromas recognized, 
recipes for celebrated healing essences being inscribed on marble 
tablets in their temples. Among the Romans, too, the custom pre- 
vailed of mingling sacred aromatic ingredients with the ashes of 
the departed — a usage not wholly to be regarded as a religious 
ceremony, but rather as a recognition of the properties ascribed to 
these agents by their Athenian neighbors. 

Indeed, the history of perfumes teems with illustrations of the 



378 A TEXT-BOOK OF MA TERIA MEDICA. 

common faith in their healing power, though from the derivation 
of the word — per, through, and fumum, smoke — the offering of 
incense, by burning aromatic woods, spices, and gums, seems to 
have been the original use suggested by them. This conception 
of the sacred and purifying influence of aromas is seen to-day in 
the censer of the ritualistic churches, as it may be traced from 
earliest recorded times through the centuries that intervene. 

The more secular regard for aromatic herbs, however, rests 
rather upon a rational, though unscientific, observation of facts 
than upon hierarchical assumption. It is recorded, for instance, 
that while cholera raged in Paris and London the gentle office in 
which they were engaged secured to the perfumers immunity from 
the plague, and that when the Dutch on the island of Ternate 
destroyed the clove tree the colony suffered from epidemics and 
disorders unknown before. 

Aromatics owe their virtues chiefly to the volatile oils they con- 
tain, which usually possess the characteristic odor and taste of the 
plants from which they are derived. These volatile oils are very 
numerous and extremely complex in their chemical structure, yet 
most have certain general features in common. The most widely 
distributed chemical constituents are terpenes, hydrocarbons of the 
aromatic series (C 5 H 8 ) n . Many of them contain, in addition, 
phenols, aldehydes, ketones, alcohols, acids, esters, lactones, and 
oxides — a few contain nitrogen or sulphur, in which case their 
action is the more complex. 

The chemical investigation of many of these oils is but just 
begun, and it is not improbable that in the isolation and purifica- 
tion of some of their constituents, valuable therapeutic agents may 
be added to the physician's armamentarium. As they agree in 
their physiological action, in large part, at least, the general effects 
are here summarized in brief. It should be remembered that many 
of these volatile oils are very widely employed in alcoholic liqueurs 
— creme de menthe, curagoa, maraschino, absinthe, kummel, char- 
treuse, etc., and therein add their effects to those of the alcohol. 

General Action. — Locally, the volatile oils are stimulant and 
irritant. Internally, they stimulate, when taken in moderate quan- 
tities, the digestive organs in the same manner as vegetable bitters, 
and increase the activity of the circulation reflexly by stim- 
ulating the sensory ends of the vagus distributed to the mucous 
membrane of the stomach. The impression is conveyed to the 
center in the medulla, and from there transmitted to the accelerator 



AROMA TICS. 379 

nerves of the heart. Very large doses depress the heart's action, 
arresting it in diastole. The poisonous action of aromatics is simi- 
lar to that of irritant narcotic poisons. Many of them are quite 
powerful local anesthetics. They first stimulate and then depress 
and exhaust the nervous system. In diseased conditions they are 
used to increase peristalsis, to impart tone to the stomach, and 
to act as antiseptics ; to arrest gastric and intestinal fermentation ; 
to relieve pain wherever they are applied ; and, by increasing the 
circulation in the brain and improving the condition of the gastro- 
intestinal tract, to relieve many of the phenomena of hysteria. 
The chief contraindication for the internal use of these drugs is in 
inflammation of the stomach and bowels. 

The volatile oils and the various preparations of the aromatics 
should be given diluted in some proper vehicle. 

AnTsum— AnTsi— Anise. U. S. jP. 

Origin. — The fruit of Pimpinella Anisum L., a plant indigenous 
in Western Asia and Egypt, and extensively cultivated in Europe. 

Description and Properties. — About \~ \ inch (3-6 Mm.) long, 
ovate compressed laterally, grayish, finely pubescent, consisting of 
two mericarps, each with a flat face, and five light-brownish filiform 
ridges, and about fifteen thin oil-tubes, perceptible in transverse sec- 
tion by the aid of the microscope. Anise has an agreeable, aro- 
matic odor, and a sweet, spicy taste. It contains from 1^- to 3 per 
cent, of a volatile oil. It resembles the fruit of the Conium, differ- 
ing from it usually in being longer and more ovate, and having 
another odor and taste. The fruit of the Conium has, moreover, 
but a single smooth mericarp without oil-tubes. 

Dose. — 8-30 grains (0.5-2.0 Gm.). 

Oleum AnTsi— Olei AnTsi— Oil of Anise. TJ. S. -P. 

Origin. — A volatile oil distilled from Anise. 

Description and Properties. — A colorless or pale-yellow, thin 
and strongly refractive liquid, having the characteristic odor of 
anise, and a sweetish, mildly aromatic taste ; neutral in reaction. 
It contains a substance known as anethol. 

Oil of anise should be kept in well-stoppered bottles, protected 
from light, and if it has separated into a liquid and a solid portion, 
it should be completely liquefied by warming before being dis- 
pensed. 

Dose. — 1-5 minims (0.06-0.3 Cc). 



380 A TEXT-BOOK OF MATERIA MEDIC A. 

Official Preparation*. 

Aqua Anisi — Aquae Anisi — Anise Water. — Dose, %.-\ fluidounce (8.0-30.0 
Cc). 

Spiritus Anisi — Spiritus Anisi — Spirit of Anise. — Dose, 1-2 fluidrachms 
(4.0-8.0 Cc). 

Oil of anise is contained in the following preparations : 

Spiritus Aurantii Comp6situs ; Syrupus Sarsaparillae Comp6situs ; Tinc- 
tura Opii Camphorata ; Trochisci Glycyrrhizae et Opii. 

Physiological Action. — Anise is slightly antiseptic, stimulant, 
and carminative ; Oil of Anise is irritant if applied in full strength to 
mucous membranes, stimulating both the digestive and circulatory- 
apparatus, improving the appetite, and slightly strengthening and 
accelerating the heart's action. In very large doses it possesses 
mildly narcotic properties. It is excreted in the urine, sweat, and 
by the bronchial mucous membrane, the secretion from which it 
liquefies. 

Therapeutics. — Anise is employed to relieve flatulence in 
children, as a sedative expectorant, and as a vehicle to flavor 
medicines. 

Cinnamomum— Cinnamomi— Cinnamon. TJ. S.JP. 

Origin. — There are three official varieties of cinnamon: 1, the 
inner bark of the shoots of Cinnamomum Zeylanicum Breyne, a 
tree about 30 feet high (9 M.), found in the forests of Ceylon 
(Ceylon Cinnamon) ; 2, the bark of the shoots of one or more 
undetermined species of Cinnamomum grown in China (Chinese 
Cinnamon, Cassia Cinnamon) ; 3, the bark of an undetermined 
species of Cinnamomum known as Cinnamomum Saigonicum 
(Saigon Cinnamon, Saigon Cassia), from Saigon, the capital of 
French Cochin-China, where it is collected and exported. 

Description and Properties. — Most of the article brought to 
the United States is the Cassia cinnamon. The varieties differ some- 
what in appearance, and are found in the shops as quills of varying 
lengths, about -^ inch (1 Mm.) or more in thickness, yellowish- 
brown in color, externally rough (Cassia), of fragrant odor, a 
sweet, aromatic taste, but less delicate than that of Ceylon cinna- 
mon, which appears in large, closely-rolled quills, composed of 
eight or more layers of bark of the thickness of paper ; pale, 
yellowish-brown, the outer surface smooth, marked with wavy 
lines of bast-bundles ; of a very sweet, fragrant odor, and a warm, 



AROMA TICS. 381 

aromatic, delicate taste. The Saigon cinnamon is found in the 
shops as large quills or broken pieces, T L- to \ inch (2 to 3 Mm.) 
thick ; the outer surface gray or light grayish-brown, with whitish 
patches, more or less rough and warty, transversely ridged and 
longitudinally wrinkled ; the inner surface cinnamon or dark brown, 
granular and slightly striate, with short and granular fracture. It 
has a fragrant odor, and a sweet, warmly aromatic, and somewhat 
astringent taste. 

Constituents. — All the varieties contain volatile oil, tannin, 
mucilage, sugar, starch, a coloring principle, and a peculiar acid. 

The official Oil of Cinnamon is distilled from Cassia Cinnamon. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparations ( Cassia Cinnamon). 

Tinctura Cardamomi Comp8sita — Tincturae Cardamomi Comp6sitae— 
Compound Tincture of Cardamom. — Cardamom, 20; Cassia Cinnamon, 20; Car- 
away, 10; Cochineal, 5; Glycerin, 50; Diluted Alcohol, q. s. ad 1000 parts. Dose, 
1-2 fluidrachms (4.0-8.0 Cc). 

Tinctura C&techu Comp6sita — Tincturae Catechu Comp6sitae — Compound 
Tincture of Catechu. — Catechu, 100; Cassia Cinnamon, 50; Diluted Alcohol, q. s. 
ad 1000 parts. Dose, \-2 fluidrachms (2.0-8.0 Cc). 

Tinctura Lavandulae CompSsita — Tincturae Lavandulae CompSsitae — Com- 
pound Tincture of Lavender. — Dose, ^-1 fluidrachm (2.0-4.0 Cc). (Formula 
given under Lavender?) 

Official Preparations {Ceylon Cinnamon). 

Tinctura Cinnamomi (10 per cent.) — Tincturae Cinnamomi — Tincture of 
Cinnamon. — Dose, %-2 fluidrachms (2.0-8.0 Cc). 

Ptilvis Aromatticus — Ptilveris Arom&tici — Aromatic Powder. — Dose, 10-30 
grains (0.6-2 Gm.). (Formula given under Cardamomum.) 

Oleum Cinnamomi— Olei Cinnamomi— Oil of 
Cinnamon. U. S. P. 

Origin. — A volatile oil distilled from Cassia Cinnamon. 

Description and Properties. — A yellowish or brownish liquid, 
becoming darker and thicker with age and exposure to the air, 
having the characteristic odor of cinnamon, and a sweetish, spicy, 
burning taste. Specific gravity, 1.055 to 1065. Soluble in an 
equal volume of alcohol, the solution being slightly acid to litmus- 
paper ; also soluble in an equal volume of glacial acetic acid. It 
should be kept in well-stoppered bottles, in a cool place, protected 
from light. 

Constituents. — Oil of cinnamon contains variable quantities of 



382 A TEXT-BOOK OF MATERIA MEDICA. 

hydrocarbons, but consists chiefly of cinnamic aldehyde, and when 
old or exposed to the air for a considerable time cinnamic acid and 
resin are formed. Cinnamic acid crystallizes in shining, colorless, 
odorless prisms, freely soluble in alcohol, ether, and boiling water. 
Chlorinated lime and hot dilute nitric acid oxidize it into oil of 
bitter almond and benzoic acid. 
Dose. — 1-5 minims (0.06-0.3 Cc). 

Official Preparations. 

Aqua Cinnamomi (0.2 per cent.) — Aquae Cinnamomi — Cinnamon Water. — 
Dose, \-\ fluidounce (15-30 Cc). 

Spfritus Cinnamomi (10 per cent.) — Spiritus Cinnamomi — Spirit of Cinna- 
mon. — Dose, 5-20 minims (0.3-1.2 Cc). 

Physiological Action. — Cinnamon is an agreeable aromatic 
stimulant, carminative, stomachic, astringent, hemostatic, and anti- 
septic. The oil possesses germicidal properties. 

Therapeutics. — The same as for other aromatics. It is much 
used to impart an agreeable flavor to medicinal compounds and as 
an adjuvant to other members of this group. Preparations of cin- 
namon are supposed to stimulate the uterus and check uterine hem- 
orrhage, and are often employed alone or in combinations with 
more powerful medicines for this purpose. 

Coriandrum— Coriandri— Coriander. XT. S. J*. 

Origin. — The fruit of Coriandrum sativum L., an annual herb 
about 2 feet (60.0 Cm.) high, indigenous in China and on the 
north-eastern shore of the Mediterranean. Cultivated in Asia, 
Europe, and America. 

Description and Properties. — Globular, about \ inch (3 Mm.) 
in diameter, slightly pointed at the apex and crowned with the 
calyx-teeth at the base. The two concave mericarps cohere, en- 
closing a lenticular cavity, each furnished on the face with two oil- 
tubes ; odor and taste agreeably fragrant and aromatic. 

Constituents. — Coriander contains nearly ^ of 1 per cent, of 
volatile oil, 13 per cent, of fatty matter, mucilage, and traces of 
tannin. 

Dose. — 8-30 grains (0.5-2.0 Gm.). 

Oleum Coriandri— Olei Coriandri— Oil of Coriander. 

XT. 8. P. 

Origin. — A volatile oil distilled from Coriander. 

Description and Properties. — A colorless or slightly yellow- 



AROMA TICS. 383 

ish liquid, having the characteristic aromatic odor of coriander, and 
a warm, spicy taste. It is one of the most stable of the volatile 
oils. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Official Preparations. 

ConfSctio SSnnse (5 per cent.) — Confectionis SSnnae— Confection of Senna. 
— Dose, 1-2 drachms (4.0-8.0 Gm.). (Formula given under Senna.) 

Splritus Junfperi Comp&situs — Spfritus Juniperi Compositi — Compound 
Spirit of Juniper. — Dose, 2-4 fluidrachms (8.0-15.0 Cc). (Formula given under 
Carum.) 

Physiological Action and Therapeutics. — The same as those 
of the other volatile oils. Frequently used as a corrective to pur- 
gative medicines. 

Foeniculum— Fceniculi— Fennel. TJ. S. J\ 

Origin. — The fruit of Foeniculum capillaceum Gilibert, an herba- 
ceous annual or perennial indigenous in Southern Europe and cul- 
tivated in Germany, France, and the United States. 

Description and Properties. — Oblong, nearly cylindrical, 
slightly curved, from \ to \ inch (4-12 Mm.) long, brownish or 
greenish-brown, readily separable into the two prominent meri- 
carps, each with five light-brown, obtuse ribs, with four oil-tubes on 
the back and two or four upon the flat face ; odor and taste aro- 
matic, anise-like. 

Constituents. — Fennel contains from 2 to 4 per cent, of volatile 
oil, which is almost identical chemically with that of anise, 12.5 
per cent, of fixed oil, and sugar. 

Dose. — 8-30 grains (0.5-2.0 Gm.). 

Official Preparation. 
Infiisum SSnnae CompSsitum — Infusi SSnnae CompSsiti — Compound In- 
fusion of Senna. — Dose, 1-2 fluidounces (30.0-60.0 Cc). (Formula given under 
Senna.) 

Oleum Fceniculi— Olei Foenlculi— Oil of Fennel. 

U. S. JP. 

Origin. — A volatile oil distilled from Fennel. 

Description and Properties. — A colorless or pale-yellowish 
liquid, having the characteristic aromatic odor of fennel, and a 
sweetish, mild, and spicy taste. Soluble in an equal volume of 
alcohol. It should be kept in well-stoppered bottles, in a cool 



384 A TEXT-BOOK OF MA TERIA MEDICA. 

place, and if it has partly or wholly solidified, it should be com- 
pletely liquefied by warming before being dispensed. 

Constituents. — It has the same constituents as the oil of anise. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Official Preparations. 

Aqua Fceniculi (2 per cent.) — Aquae Fceniculi — Fennel Water. — Dose, ^-1 
fluidounce (8.0-30.0 Cc). 

Ptilvis Glycyrrhizae CompSsitus — Ptilveris Glycyrrhizae CompSsiti — Com- 
pound Liquorice Powder. — Dose, \-2 drachms (2.0-8.0 Gm.). (Formula given under 
Senna.) 

Spiritus Juniperi CompSsitus (0.5 per cent.) — Spiritus Juniperi Compositi — 
Compound Spirit of Juniper. — Dose, 2-4 fluidrachms (8.0-15.0 Cc). (Formula 
given under Carum.) 

Physiological Action and Therapeutics are the same as those 
of anise. 



Carum— Cari— Caraway. U. S. JP. 

Origin. — The fruit of Carum Carvi L., a biennial plant native 
to Central and Western Asia. It is cultivated in Europe and in the 
United States. 

Description and Properties. — Oblong, laterally compressed, 
about \ to \ inch (4-5 Mm.) in length, tapering somewhat at the 
ends, brown, with five yellowish, filiform ribs, and six oil-tubes. 
Caraway has an agreeable odor and a sweetish, spicy taste. 

Constituents. — It contains from 5 to 7 per cent, of a volatile 
oil. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

Official Preparation. 

Tinctura Cardamomi Comp6sita (10 per cent.) — Tincturae Cardamomi 
Compositae — Compound Tincture of Cardamom. — Dose, 1-2 fluidrachms (4.0- 
8.0 Cc). (Formula given under Cardamomum.) 

Oleum Cari— Olei Cari— Oil of Caraway. TJ. 8. J>. 

Origin. — A volatile oil distilled from Caraway. 

Description and Properties. — A colorless or pale-yellow, thin 
liquid, having the characteristic aromatic odor of caraway and a 
mild, spicy taste. Soluble in an equal volume of alcohol, this 
solution being neutral to litmus-paper. 

By fractional distillation the oil may be separated into two 



AROMA TICS. 385 

portions : a light hydrocarbon with but little odor and taste, 
carvene, and a heavy oil having an agreeable caraway odor, carvol, 
and isomeric with menthol, myristicol, and thymol. 
Dose. — 1-10 minims (0.6-0.66 Cc). 

Official Preparation. 

Spfritus Juniperi Compositus (0.05 per cent.) — Spiritus Junrperi CompSsiti — 
Compound Spirit of Juniper. — Oil of Juniper, 4 ; Oil of Caraway, \ ; Oil of Fennel, 
y 2 ; Alcohol, 0.7; Water, q. s. ad 1000 parts. Dose, 2-4 fluidrachms (8.0-15.0 Cc). 

Physiological Action and Therapeutics. — The same as those 
of the other aromatic oils. 

Capsicum— Capsici— Capsicum. 77. S. JP. 

(Cayenne Pepper.) 

Origin. — The fruit of Capsicum fastigiatum Blume, a small 
crooked-branched shrub, I to 2 feet (30-60 Cm.) high, indigenous 
in tropical America and Asia, and cultivated in gardens. The 
fruit is an oblong-conical pod from \ to \ inch (8-19 Mm.) long, 
of a crimson or yellow color. It encloses two or three cells con- 
taining flat, reniform, yellowish seeds, attached to a thick, central 
placenta. These pods when dried and ground form capsicum, 
which has a peculiar odor and an intensely hot, aromatic taste. 
This ground product is of a bright-red color, fading upon long 
exposure to the light. Capsicum of the market usually consists 
of several species ground together, and is often adulterated with 
sawdust and sometimes with red lead. 

Constituents. — Capsicum contains capsaicin, an acrid principle 
found in the greatest amount in the African product ; also a vola- 
tile alkaloid, fixed and volatile oil, and fat acids. 

Dose. — 3-5 grains (0.2-0.3 Gm.). 

Official Preparations. 

Extr3ctum Capsici Fluidum — Extr^cti Capsici Kluidi — Fluid Extract of 
Capsicum. — Dose, \-\.o 2 minims (0.03-0.12 Cc). 

Empiastrum CSpsici — Empiastrum (ace.) Capsici — Capsicum Plaster. For 
external use. 

Oleoresina C&psici — Oleoresinae Capsici — Oleoresin of Capsicum. — Dose, 
\-i minim (0.015-0.06 Cc). 

Tinctiira Capsici — Tincturae Capsici — Tincture of Capsicum.— Dose, 5-20 
minims (0.3-1.2 Cc). 

Physiological Action. — Externally and Locally. — Capsicum is 

25 



386 A TEXT-BOOK OF MATERIA MEDICA. 

an irritant and rubefacient, producing vesication if kept in contact 
with the skin for a long time. It so irritates the mucous membrane 
of the mouth and nose as to induce sneezing. 

Internally. — Digestive System. — Capsicum is a powerful gastro- 
intestinal stimulant, increasing the flow from the salivary, gastric, 
and intestinal glands. It increases the blood-supply to, and stimu- 
lates the walls of, the stomach, occasioning a sense of heat. It is 
a powerful carminative. Large doses produce great irritation in 
the stomach and bowels. 

Circulatory System. — It is a powerful stimulant to the heart, 
greatly increasing the strength and rapidity of its action. 

Absorption and Elimination. — It is chiefly eliminated by the kid- 
neys, increasing the flow of urine. Large doses may produce 
vesical tenesmus, and aphrodisiac effects have sometimes been pro- 
duced. 

Therapeutics. — Externally and Locally. — Owing to its counter- 
irritant action, capsicum is employed to relieve lumbago, torticollis, 
neuralgia, rheumatic pains, and acute inflammations of the skin or 
mucous membrane. An infusion or the diluted tincture is an 
excellent gargle in relaxed uvula, pharyngitis, and the angina of 
scarlet fever. 

The tinctures of capsicum and cantharides have been used to 
stimulate the scalp in the various forms of alopecia. The tincture 
is frequently used as a domestic remedy for the benefit of chilblains 
and toothache. 

Internally. — Capsicum is a most valuable stomachic in an atonic 
condition of the digestive organs, and a very efficient remedy in 
the irritable and catarrhal conditions of the stomach due to the ex- 
cessive use of alcohol. 

The tincture of capsicum or the powdered drug, added to hot 
water or to hot water and whiskey, makes a valuable and rapid car- 
diac and vascular stimulant. 

Contraindications. — Capsicum and its preparations should not 
be given in acute inflammatory affections of the gastro-intestinal 
and genito-urinary tracts. 

Administration. — The oleoresin and the powder should be 
given in pills or capsules. The fluid extract and the tincture should 
be administered well diluted with water. 



AROMA TICS. 387 

Piper— Piperis— Pepper. U. S. P. 

(Black Pepper.) 

Origin. — The unripe fruit of Piper nigrum L., a knotted, pointed- 
branched, aromatic, climbing shrub, indigenous in India, and culti- 
vated in many of the East Indian and Philippine and some of the 
West Indian islands. 

Constituents. — Its important constituents are a volatile oil (1 to 
2 per cent.) ; a neutral principle, piperin (6 to 8 per cent.) ; and a 
pungent, soft, dark-green resin, to which the acrid taste and medici- 
nal properties of pepper are due. 

Dose. — 5-20 grains (0.3-1.2 Gm.) 

Official Preparations. 

Oleoresfna Piperis — Oleoresinae Piperis — Oleoresin of Pepper. — Dose, \-\ 
grain (0.015-0.06 Gm.). 

Piperlnum — Piperini — Piperin. — Origin. — A neutral principle obtained from 
Pepper, as well as from other plants of the natural order Piperacece. 

Description and Properties. — Colorless, or pale-yellowish, shining, prismatic crystals, 
odorless, and almost tasteless when first taken into the mouth, but after a while pro- 
ducing a sharp, biting sensation. Permanent in the air ; almost insoluble in water, but 
soluble in 30 parts of alcohol and in I part of boiling alcohol. 

Dose. — 1-10 grains (0.03-0.6 Gm.). 

Derivative Compound. 

Piperonal — Heliotropin. — Obtained from Piperic Acid by oxidation. It occurs in 
small white crystals, soluble in about 600 parts of cold water, and very readily soluble in 
alcohol and ether. The dose is 10-15 grains (0.6-1.0 Gm.). It has been used as an 
antiseptic and antipyretic. 

Physiological Action and Therapeutics of pepper and its 
preparations are almost identical with those of capsicum. 

Pepper, particularly piperin, possesses antiperiodic and anti- 
septic properties to a greater extent than capsicum. 

Myristica— Mynsticae— Nutmeg. U.S. JP. Macis— 
Macidis— Mace. U. S. JP. 

Origin. — The seed (Myristica) and the membrane, " arillode," 
investing the kernel (Mace) of Myristica fragrans Houttuyn, a tree 
about 30 feet (9 M.) high, found in the Molucca Islands and cul- 
tivated in the East Indies. 



Oleum Mynsticae— Olei Mynsticae— Oil of Nutmeg. 

U. S. JP. 

Origin. — A volatile oil distilled from Nutmeg. 



388 A TEXT-BOOK OF MA TERIA MEDICA. 

Description and Properties. — A thin, colorless or pale-yel- 
lowish liquid, having the characteristic odor of nutmeg and a 
warm, spicy taste. It becomes darker and thicker by age and ex- 
posure to the air. Soluble in an equal volume of alcohol. It 
should be kept in well-stoppered bottles, in a cool place, protected 
from light. 

Dose. — 1-3 minims (0.06-0.18 Cc). 

Official Preparation. 

Spiritus Myristicse (5 per cent.) — Spiritus Myristicae — Spirit, or Essence, of 
Nutmeg. — Dose, 15-60 minims (1.0-4.0 Cc). 

Physiological Action and Therapeutics are the same as those 
of anise. 



Caryophyllus— Caryophylli— Cloves. U. S. J\ 

Origin. — The unexpanded flowers of Eugenia- aromatica (L.) O. 
Kuntze, a hard-wood, shrubby evergreen. It was originally found 
in the Molucca Islands, whence it was introduced and cultivated 
among the East Indian Islands. 

Description and Properties. — The buds are about f inch (15 
Mm.) long, dark -brown, consisting of a subcylindrical, solid and 
glandular calyx-tube, terminated by four teeth and surmounted by 
a globular head, formed by four petals covering numerous curved 
stamens, and one style. A clove resembles a nail (L. clavus ; Fr. 
clou). 

Cloves have a strong aromatic odor and a pungent, spicy taste, 
and when pressed or scratched emit oil. 

Constituents. — Cloves contain about 18 per cent, of a highly 
pungent volatile oil, 17 per cent, of tannin, and small quantities of 
fixed oil, gum, resin, etc. Two crystalline principles have been 
separated : caryophyllin, a white, resinous substance — a stearopten 
— odorless and tasteless ; and eugenin, a substance soluble in boil- 
ing alcohol and isomeric with eugenol, a constituent of the volatile 
oil. 

Dose. — 5-10 grains (0.3-0.6 Gm.). 

Official Preparation. 

Tinctura Lavandulae Compdsita — Tinctiirae Lavandulae CompSsitae — Tinc- 
ture of Lavender. — Dose, \-\ fluidrachm (2.0-4.0 Cc). (Formula given under 
Lavender.} 



AROMA T/CS. 389 

Oleum Caryophylli— Olei Caryophylli— Oil of Cloves. 

U. S. P. 

Origin. — A volatile oil distilled from Cloves. 

Description and Properties. — A pale-yellow, thin liquid, be- 
coming darker and thicker by age and exposure to the air, having 
a strongly aromatic odor of cloves and a pungent, spicy taste. Its 
specific gravity is 1. 060-1. 067. Soluble in an equal volume of 
alcohol, the solution being slightly acid to litmus-paper. 

Constituents. — Oil of cloves consists of a light and a heavy 
oil, the former a hydrocarbon, supposed to be inactive ; the latter 
a phenol-like liquid termed eugenol, a colorless oil, with the odor 
of cloves, a specific gravity of 1.076 to 1.0785, yielding with bases 
crystalline salts. Schenck has demonstrated the presence of sali- 
cylic acid in oil of cloves. 

Dose. — 1-10 minims (0.06-0.6 Cc). 

Allied Compounds and Derivatives. 

B&nzoyl-eugenol. — Origin. — From Eugenol. 

Description and Properties. — It occurs in neutral, odorless, colorless, acicular crys- 
tals, having a feebly bitter taste ; soluble in hot alcohol, ether, and chloroform, and 
insoluble in water. 

Dose. — Not yet determined. 

Cinnamyl-eugenol. — Origin. — A derivative of Eugenol. 

Description and Properties. — Colorless, odorless, tasteless, lustrous needles, soluble 
in hot alcohol, ether, and chloroform, and insoluble in water. 

Eugenyl-ac&tamide. — Origin. — Obtained from Eugenol-acetic-ethyl-ether by 
treating with solution of Ammonia. It occurs as a crystalline powder. 

Physiological Action. — Externally and Locally. — Oil of cloves 
is a counter-irritant, local anesthetic, and germicide. 

Internally. — Its action is essentially the same as that of anise, it 
being a powerful carminative and stimulant. 

Therapeutics. — Externally and Locally. — Oil of cloves is em- 
ployed as a local anesthetic in toothache, earache, and neuralgia, 
and as a synergist to other counter-irritants, rubefacients, and anti- 
septics. The eugenol-acetamide is a powerful local anesthetic, 
being analogous to cocaine in its action. 

Internally. — The therapeutics are similar to those of anise. 
The benzoyl-eugenol has been highly recommended by some prac- 
titioners as a valuable remedy in tubercidosis. The author has suc- 
cessfully employed the following combination as an antiseptic and 
antifermentative in gastric fermentation, to be administered either in 



390 A TEXT-BOOK OF MATERIA MEDIC A. 

soft capsules, with olive oil as a vehicle, or in the form of an emul- 
sion : 

R. Olei Caryophylli, 
Olei Cinnamomi, 
Olei Menthae Piperita, 
Creosoti, da. Try. 

M. Sig. — Take at one dose. 

The better way to administer it is in the form of soft capsules, 
each capsule containing the above dose in about 6 minims (0.37 Cc.) 
of olive oil. One or two capsules should be given three times a 
day, after meals. 

Pimenta— Pimentae— Pimenta. U. 8. JP. 

(Allspice.) 

Origin. — The nearly ripe fruit of Pimenta officinalis Lindley, an 
evergreen tree about 30 feet (9 M.) high, indigenous in the West 
Indies, Central America, and the northern part of South America. 

Constituents. — The most important constituent is the volatile 
oil, of which the fruit yields from 3 to 4 per cent. 

Oleum Pimentae— Olei Pimentae— Oil of Allspice. 

U. 8. P. 

Origin. — A volatile oil distilled from Pimenta. 

Description and Properties. — A colorless or pale-yellow liquid, 
having a strong, aromatic, clove-like odor, and a pungent, spicy 
taste. It becomes darker and thicker with age and exposure. 
With an equal volume of alcohol it forms a clear solution. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Physiological Action and Therapeutics are similar to those of 
cloves. 

Oleum Cajuputi— Olei Cajuputi— Oil of Cajuput. 

U. 8. JP. 

Origin. — A volatile oil distilled from the leaves of Melaleuca 
leucadendron L., a tree with crooked stem and scattered branches, 
resembling the weeping willow, indigenous in the East Indies. 

Description and Properties. — A light, thin, bluish-green, or, 
after rectification, colorless liquid, having a peculiar, agreeable and 
distinctly camphoraceous odor, and an aromatic, bitterish taste. 
Specific gravity, 0.922. With an equal volume of alcohol it affords 



AROMATICS. 391 

a clear solution, which either has a slightly acid reaction or, in the 
case of the rectified oil, is neutral to litmus-paper. 

Constituents. — The chief constituent is cajuputol, the hydrate 
of the hydrocarbon cajuputene. Cajuputol is identical with euca- 
lyptol. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Physiological Action and Therapeutics are identical with those 
of the oil of cloves. 

Cardamomum— Cardamomi— Cardamom. U. S. P. 

Origin. — The fruit of Elettaria repens (Sonnerat) Baillon, a per- 
ennial plant 6 to 10 feet (1.8-3 M.) high. 

Cardamom is indigenous in Hindustan, in the mountainous 
regions of Malabar. 

The same plant furnishes three varieties of cardamoms, known 
in commerce as the shorts, short-longs, and long-longs. 

Description and Properties. — Ovoid or oblong, from f to J 
inch (12 Mm.-2 Cm.) long, obtusely triangular, rounded at the 
base, beaked, longitudinally striate ; of a pale-buff coior, three- 
celled, with a thin, leathery, nearly tasteless pericarp and a central 
placenta. The seeds are about \ inch (5 Mm.) long and \ inch (3 
Mm.) broad, reddish-brown, angular, rugose, depressed at the 
hilum, surrounded by a thin membranous arillus. They have an 
agreeable odor and a pungent, aromatic taste. 

The seeds contain 10 per cent, of fixed oil and 4.6 per cent, of a 
volatile oil, besides albuminous matter, gum, starch, etc. The 
volatile oil possesses the odor and taste of the seeds, is colorless 
or yellowish, dextrogyre, contains oxygen, and has a specific 
gravity of 0.93 to 0.94. 

Dose. — 5-15 grains (0.3-1 Gm.). 

Official Preparations. 

Tinctura Cardamomi (10 per cent.) — Tincturae Cardamomi — Tincture of 
Cardamom. — Dose, 1-2 fluidrachms (4.0-8.0 Cc). 

Tinctura Cardamomi Comp6sita — Tincturae Cardamomi Comp5sitae — 
Compound Tincture of Cardamom. — Cardamom, 20; Cinnamon, 20; Caraway, 10; 
Cochineal, 5; Glycerin, 50; Dilute Alcohol, q. s. ad 1000 parts. Dose, 1-2 fluid- 
drachms (4.0-8.0 Cc). 

Piilvis AromaUcus— Ptilveris Arom&tici— Aromatic Powder.— Ceylon Cinna- 
mon, 35; Ginger, 35; Cardamon, 15; Nutmeg, 15. Dose, 10-30 grains (0.6- 
2.0 Gm.). 

There is also a fluid extract made from this powder. Dose, 10-30 minims (0.6- 
2.0 Cc). 



392 A TEXT-BOOK OF MA TERIA MEDICA. 

Antagonists and Incompatibles. — Free acids are incompatible 
with the compound tincture of cardamom, separating insoluble car- 
minic acid in it. 

Physiological Action. — In this respect Cardamom conforms to 
the general character of the Aromatic Group. 

Therapeutics. — Essentially the same as for other members of 
this group. Cardamom is used principally as an adjuvant to other 
aromatics, stimulants, stomachics, and carminatives. 

Zingiber— Zinglberis— Ginger. U. S. P. 

Origin. — The rhizome of Zingiber officinale Roscoe, a perennial 
herb indigenous in tropical Asia and now cultivated in most tropi- 
cal countries. 

Description and Properties. — A thick, flattish rhizome from i 
to 4 inches (25 to 100 Mm.) long, with club-shaped lobes on one 
side ; deprived of the corky layer, pale, buff-colored, striate, 
breaking with a mealy, rather fibrous fracture, showing numerous 
small, scattered resin-cells and fibro-vascular bundles, the latter 
enclosed by a nucleus sheath. Agreeably aromatic, and of a warm, 
pungent taste. 

Ginger contains from f to 2 per cent, of a pale-yellow, volatile 
oil, to which the ginger owes its aromatic properties ; also a soft 
resin, giving to the drug its hot, pungent taste. The proportion 
of resin present varies with the different varieties of ginger, that 
from the East Indies yielding about 8 per cent., while the Jamaica 
product yields only about 5 per cent. 

Dose. — 8-30 grains (0.5-2.0 Gm.). 

Official Preparations. 

Extractum Zingiberis Fluidum— Extract! Zingiberis Fluid! — Fluid Ex- 
tract of Ginger. — Dose, 10-30 minims (0.6-2.0 Cc). 

Oleoresina Zingiberis — Oleoresinae Zingiberis — Oleoresin of Ginger. — 
Dose, 1-3 grains (0.06-0.18 Gm.). 

Pulvis AromSticus — Piilveris Arom&tici — Aromatic Powder. — Dose, 10-30 
grains (0.6-2.0 Gm.). (Formula given under Cardamomum.) 

Piilvis Rhei Compdsitus — Piilveris Rhei Compositi — Compound Powder 
of Rhubarb. — Rhubarb, 25 ; Magnesia, 65 ; Ginger, 10 parts. Dose, y 2 -l drachm 
(2.0-4.0 Gm.). 

Syrupus Zingiberis — Syrupi Zingiberis — Syrup of Ginger. — Dose, y 2 -2 
drachms (2.0-8.0 Cc). 

Tinctura Zingiberis — Tinctiirae Zingiberis — Tincture of Ginger. — Dose, 1-2 
fiuidrachms (4.0-8.0 Cc). 

Trochisci Zingiberis— Trochiscos (ace) Zingiberis— Troches of Ginger.— 
Dose, use freely as required. 



AROMATICS. 393 

Physiological Action and Therapeutics are almost identical 
with those of other aromatics. Ginger is especially valuable as a 
stomachic and carminative, to stimulate the stomach, improve the 
appetite, and relieve flatulency and colic. It is a safe and efficient 
domestic remedy for the relief of simple diarrhea. It is also much 
used as a corrective to modify the taste and action of other 
medicines. 

Calamus— Calami— Calamus. U. S. P. 

(Sweet Flag.) 

Origin. — The rhizome of Acorus Calamus L., a plant indige- 
nous in North America, Europe, and Western Asia, growing in 
swamps and along the shores of streams and ponds. 

Description and Properties. — Calamus is found in subcylin- 
drical sections of various lengths, about I inch (2 Cm.) broad, 
externally reddish-brown, internally whitish, of a spongy texture, 
breaking with a short, corky fracture, showing numerous oil-cells 
and scattered wood-bundles. It has a strong aromatic, fragrant 
odor, and a warm, peculiar, bitterish taste. Calamus contains from 
1 to 2 per cent, of volatile oil possessing the odor and taste of cal- 
amus, a glucosid (acorin) in the form of a bitter, yellow syrupy 
liquid, besides calamine, choline, resin, starch, and mucilage. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Official Preparation. 

Extr^ctum Calami Fluidum— ExtrScti Calami Fluidi— Fluid Extract of 
Calamus. — Dose, 15-60 minims (1.0-4.0 Cc). 

Physiological Action and Therapeutics. — The action of cala- 
mus is similar to that of anise, but it is more tonic than the latter. 
Large doses of the volatile oil produce tetanic convulsions. 

It is used for the same purposes as anise, but probably possesses 
more stomachic and carminative properties. 

Oleum Lavandulae Florum— Olei Lavandulae Florum 
— Oil of Lavender Flowers. U. S. P. 

Origin. — A volatile oil distilled from fresh flowers of Lavandula 
officinalis Chaix. Lavender is native to Southern Europe and 
cultivated in gardens. 

Description and Properties. — A colorless or yellowish liquid, 



394 A TEXT-BOOK OF MATERIA MEDICA. 

having the fragrant odor of lavender flowers and a pungent and 
bitterish taste. Soluble in all proportions of alcohol. It should 
be kept in well-stoppered bottles, in a cool place, protected from 
light. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Official Preparations. 

Spfritus Lavandulae (5 percent.) — Splritus Lavandulae — Spirit of Lavender. 
—Dose, %,-\ fluidrachm (2.0-4.0 C.c). 

Tinctiira Lavandulae CompSsita — Tinctiirae Lavandulae Comp6sitae — Com- 
pound Tincture of Lavender. — Oil of Lavender, 8; Oil of Rosemary, 2; Cassia 
Cinnamon, 20; Cloves, 5; Nutmeg, 10; Red Saunders, 10; Alcohol, 0.7; Water, 250; 
Diluted Alcohol, q. s. ad 1000 parts. Dose, y 2 -\ fluidrachm (2.0-4.0 Cc). Com- 
pound Tincture of Lavender is an ingredient of Liquor Potassii Arsenitis. 

Physiological Action and Therapeutics are the same as those 
of other volatile oils mentioned in this group. 



Mentha Piperita— Menthae Piperitae— Peppermint. 

U. S. P. 

Origin. — The leaves and tops of Mentha piperita Smith, a 
perennial plant found in damp places in England and other Euro- 
pean countries and in North America. 

Peppermint contains about I per cent, of a volatile oil — its most 
important constituent. 

Official Preparation. 

Spfritus M6nthae Piperitae (10 per cent.) — Spfritus MSnthae Piperitae — Spirit, 
or Essence, of Peppermint. — Dose, 5-60 minims (0.3-0.4 Cc). 
Spirit of Peppermint is an ingredient of Mistura Rhei et Sodae. 

Oleum Menthae Piperitae— Olei Menthae Piperitae— 
Oil of Peppermint. U. S. JP. 

Origin. — A volatile oil distilled from Peppermint. 

Description and Properties. — A colorless or yellowish or 
greenish-yellow liquid, becoming darker and thicker by age and 
exposure to the air, having the characteristic strong odor of pep- 
permint, and a strongly aromatic, pungent taste, followed by a 
sensation of cold upon inhalation. It forms a clear solution with 
an equal volume of alcohol, becoming turbid when further diluted, 
and is soluble in all proportions in carbon disulphide and in glacial 
acetic acid. 



AROMA TICS. 395 

When exposed to a freezing temperature the oil becomes thick 
and cloudy, and separates crystals of menthol, to which it owes its 
peculiar odor. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Official Preparations. 

Aqua MSnthae Piperitae (0.2 per cent.) — Aquae MSnthae Piperita? — Pepper- 
mint Water.— Dose, y 2 -i flmdounce (15.0-30.0 Cc). 

Trochisci MSnthae Piperitae (.01 Cc. in each) — Trochiscos (ace.) MSnthae 
Piperitae — Troches of Peppermint. — Dose, freely as desired. 



Menthol— Menthol— Menthol. 77. 8. P. 

Origin. — A stearopten obtained from the official Oil of Pepper- 
mint or from Japanese or Chinese Oil of Peppermint. 

Description and Properties. — Colorless, acicular or prismatic 
crystals, having a strong and pure odor of peppermint, and a 
warm, aromatic taste, followed by a sensation of cold when air is 
inhaled. Menthol is but slightly soluble in water, but imparts to 
the latter its odor and taste. It is freely soluble in alcohol, ether, 
chloroform, carbon disulphide, and glacial acetic acid. 

Dose. — J-2 grains (0.03-0.12 Gm.). 

Allied Compounds. 

Benzoate of Menthol ; Chloral Menthol. — These combinations are quite active 
local anesthetics and analgesics. 

Physiological Action and Therapeutics. — Externally and Lo- 
cally. — Menthol is an antiseptic, antipruritic, analgesic, and anes- 
thetic, as well as a germicide. It is used for the same purposes as 
oil of cloves. It is used extensively in headache, being rubbed 
on the forehead. Owing to its analgesic properties, it is used in 
the form of an ointment in various strengths for painful hemor- 
rhoids, burns, boils, and superficial inflammations. 

The oil of peppermint, or menthol, is an ingredient of many 
sprays and lotions for the treatment of diseases of the ear, nose, and 
throat. 

As an antipruritic menthol is a valuable remedy to relieve the 
itching of eczema, pruritus, urticaria, etc. It should be dissolved 
in oil for this purpose — in severe cases 50 grains to I ounce (3.2 
Gm. to 30.0 Cc). 

Internally. — The uses of oil of peppermint are similar to 



396 A TEXT-BOOK OF MA TERIA MEDICA. 

those of other aromatic oils, it being a valuable carminative, stimu- 
lant, antifermentative, and antispasmodic. In small doses menthol 
has been given to allay nausea and vomiting and to relieve the 
pain of gastralgia. 

Mentha Viridis— Menthae Vlridis— Spearmint. 

U. S. P. 

This is one of the mints, found in the same localities as 
peppermint, and containing, like the latter drug, a volatile oil 
forming its active constituent. It possesses milder properties than 
peppermint, although similar to it in its action and uses. To some 
people it has a more agreeable taste than peppermint, and in 
infantile cases it is usually preferred. 

Official Preparations. 

Aqua MSnthae Viridis — Aquse MSnthae Viridis — Spearmint Water. 

Spiritus Menthae Viridis — Spiritus Menthae Viridis — Spirit, or Essence, of 
Spearmint. 

The dose of the oil of spearmint and of the above preparations is the same as for 
the corresponding oil and preparations of peppermint. 

Thymol— Thymol— Thymol. U. S. r. 

Origin. — A phenol or stearopten occurring in, and obtained by, 
freezing or distilling the volatile oils of Thymus vulgaris, Thymus 
monarda, and Carum ajowan. 

Description and Properties. — Large, colorless, translucent 
crystals of the hexagonal system, having an aromatic, thyme-like 
odor, and a pungent aromatic taste, with a very slight caustic effect 
upon the lips. Its specific gravity as a solid is 1.069, but when 
liquefied by fusion it is lighter than water. It is soluble in about 
1200 parts of water and in less than its own weight of alcohol, 
ether, or chloroform ; also readily soluble in carbon disulphide, 
glacial acetic acid, and in fixed or volatile oils. When triturated 
with about equal quantities of camphor, menthol, or chloral, it 
liquefies. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Allied and Derivative Compound. 

Thym&cetin, a derivative of thymol, prepared after the manner of phenacetin, and 
holding the same relation to thymol as phenacetin does to phenol (carbolic acid). It is 
a white, ciystalline powder, sparingly soluble in water. Dose, 3-10 grains (0.2-0.6 
Gm.). 






AROMA TICS. 397 

Physiological Action and Therapeutics are similar to those of phenacetin, thymace- 
tin possessing marked analgesic and hypnotic properties. 

Physiological Action. — Thymol is a powerful antiseptic, being 
ten times less poisonous than carbolic acid, yet as an antiseptic far 
superior to it. While stimulant, it is not irritant or corrosive. It 
is also a deodorant, disinfectant, parasiticide, and local anesthetic, 
as well as an antipruritic, antipyretic, and antifermentative. 

Absorption and Elimination. — It is eliminated chiefly by the 
lungs and kidneys, producing some irritation at the points of 
elimination. The urine is increased in quantity, often assuming a 
dark greenish hue. 

Untoward Action. — The following symptoms have been pro- 
duced by the administration of large doses : burning sensation in 
the mouth and stomach, persisting in some instances for days, 
accompanied by pain and tenderness under pressure. According 
to Balz, " perspiration is sometimes observed, and occasionally a 
transient buzzing in the ears and deafness." 

Poisoning. — In addition to untoward manifestations, there may 
be nausea and vomiting, profuse sweating, great reduction of tem- 
perature, dizziness, violent delirium, and collapse. 

Therapeutics. — Externally and Locally. — The applications of 
thymol in surgery are identical with those of carbolic acid. Among 
surgeons who recommend and use it is Mr. Spencer Wells, who 
employs it in a solution of I : iooo for spray, irrigation, sponges, 
instruments, and all other antiseptic purposes. 

Crocker in 1878 introduced it as an efficient remedy in certain 
skin diseases. It probably owes its value in these cases to its anti- 
pruritic and antiparasitic properties. 

It is also extensively used in diseases of the nose, throat, and 
ear, and in certain disorders of the genito-urinary tract. Thymol 
is also administered by inhalation in certain broncho-pulmonary 
disorders. 

Internally. — Thymol is used for the same purposes as other 
antiseptics, such as carbolic acid, resorcin, beta-naphtol, etc. 

Martini highly recommends it as an intestinal antiseptic in the 
treatment of diarrhea, dysentery, and typhoid fever. 

Bulfalini has employed it with some success in limiting fermen- 
tation during a proteid diet in the treatment of diabetes. It has 
also been favorably recommended in phthisis, vesical catarrh, sto- 
matitis, and diphtheria. 



398 A TEXT-BOOK OF MATERIA MEDICA. 

Administration. — It may be applied externally in solution 
(i : iooo), as an ointment (i-io per cent.), or in the form of thymol 
gauze as a surgical dressing (i per cent, of thymol). 

For internal use it should be given in pills or capsules. 



Oleum Gaultheriae— Olei Gaultheriae— Oil of Winter- 
green. TJ. S. P. 

Origin. — A volatile oil distilled from the leaves of Gaultheria 
procumbens L., a small evergreen plant indigenous in the northern 
hemisphere and bearing a scarlet, fleshy, berry-like fruit. 

Description and Properties. — The volatile oil is a colorless or 
yellow, or occasionally reddish, liquid, having a characteristic, 
strongly aromatic odor, and a sweetish, warm, and aromatic taste. 
Specific gravity, 1.175 to 1. 185. 

It consists almost entirely of methyl salicylate. It should be 
kept in well-stoppered bottles, protected from light. 

Dose. — 2-10 minims (0.12-0.6 Cc). 

Official Preparation. 

Splritus Gaultheriae — Splritus Gaultheriae — Spirit of Gaultheria (Essence 
of Wintergreen). — Dose, 1-2 fluidrachms (4.0-8.0 Cc). 

Physiological Action. — Externally and Locally. — Oil of winter- 
green is a stimulant and a powerful antiseptic. 

Internally. — Its action is identical with that of salicylic acid and 
its salts, but it does not depress the heart like the latter drugs. 

Therapeutics. — Externally and Locally. — Used for the same 
purposes as oil of cloves and other aromatic oils. 

Internally. — Used for the same purposes as salicylic acid. 



CLASS II-SYMPTOM MEDICINES. 



GROUP L— ANTISPASMODICS. 

Antispasmodics are remedies used to allay spasm and quiet 
nervous excitement or improve unfavorable conditions of the 
mind, as in cases of convulsions, hysteria, melancholia, hypo- 
chondriasis, etc. They act as stimulants to the brain and higher 
nervous centers, and as depressants of the lower centers, diminish- 
ing muscular activity and, partly through their action upon the 
higher nervous centers, increasing the co-ordinating power. They 
are to a considerable degree cardiac stimulants, diaphoretics, ex- 
pectorants, and antiseptics. 

AsafcBtida— Asafoetidae— Asafetida. 77. S. P. 

Origin. — A gum resin obtained from the root of Ferula foetida 
(Bunge) Regel, a large perennial herb found in Turkestan, Western 
Thibet, and Western Afghanistan. 

Description and Properties. — Irregular masses composed of 
whitish tears imbedded in a yellowish- or brownish-gray, sticky 
mass. The tears when hard break with a conchoidal fracture, 
showing a milk-white color, which changes, on exposure, to pink, 
and finally to brown. The drug has a persistent alliaceous odor 
and a bitter, alliaceous, acrid taste. When triturated with water it 
yields a milk-white emulsion, which becomes yellow upon the addi- 
tion of ammonia water. It is partly soluble in ether, and at least 
60 per cent, of it should dissolve in alcohol. 

Dose. — 5-8 grains (0.3-0.5 Gm.). 

Official Preparations. 

Emiilsum Asafoetidae — Emiilsi Asafoetidae — Emulsion of Asafetida. —Dose, 
2-4 fluidrachms (7.39-15 Cc). 

Pllulae Aloes et Asafoetidae — Pllulas (ace.) Aloes et Asafoetidae. — Pills of 
Aloes and Asafetida. — Dose, 2 to 5 pills. 

Pilulae Asafoetidae — Pflulas (ace.) Asafoetidae— Pills of Asafetida. — Dose, 
2 to 5 pills. 

Tinctiira Asafoetidae — Tinctiirae Asafoetidae — Tincture of Asafetida (20 
per cent.). — Dose, 10-40 minims (0.6-2.5 Cc). 

.399 



400 A TEXT-BOOK OF MATERIA MEDICA. 

Ammoniacum— Ammonlaci— Ammoniac. TJ. S. I*. 

Origin. — A gum resin obtained from Dorema Ammoniacum 
Don, a plant 6 or 7 feet (2 M.) high, found in the deserts and 
barren regions of Persia and Tartary. 

Description and Properties. — Roundish tears, ^-J inch (1.5- 
12 Mm.) in diameter; externally pale yellowish-brown, internally 
milk-white ; brittle when cold, and breaking with a flat, conchoidal, 
and waxy fracture ; or the tears are superficially united into irreg- 
ular masses without any intervening dark-colored substance. It 
has a peculiar odor and a bitter, acrid, and nauseous taste. When 
triturated with water it readily yields a milk-white emulsion. It 
contains from 1.8 to 4 per cent, of volatile oil, 70 to 72 per cent. 
of resin, and 18 to 22 per cent, of gum. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Official Preparations. 

Empiastrum Ammonlaci cum Hydrargyro — Empl&stra Ammonlaci cum 
Hydrargyro — Ammoniac Plaster with Mercury. — For external use. 

Emtilsum Ammonlaci — Emiilsi Ammonlaci — Emulsion of Ammoniac 

(4 per cent.). — Dose, y 2 -\ fluidounce (15 to 30 Cc.). 

Camphora— Camphorae— Camphor. IT. S. jP. 

Origin. — A stearopten (of the nature of a ketone) obtained 
from Cinnamomum camphora L., and purified by sublimation. The 
camphor laurel is a handsome tree 25 to 30 feet (7.5-9 M.) high, 
indigenous in Eastern and Southeastern Asia, and cultivated in 
Italy as an ornamental tree. 

Description and Properties. — White, translucent masses, of a 
tough consistence and crystalline structure, readily pulverizable in 
the presence of a little alcohol, ether, or chloroform ; having a 
penetrating, characteristic odor and a pungently aromatic taste. 
Very sparingly soluble in water, but readily soluble in alcohol, 
ether, chloroform, carbon disulphide, benzin, and in fixed and vola- 
tile oils. 

When camphor is triturated in about molecular proportions 
with menthol, thymol, phenol, or chloral hydrate, liquefaction 
ensues. It melts at 175 C. (347 F.), boils at 204° C. (399.2 F.), 
and is inflammable, burning with a luminous, smoky flame. On 
exposure to the air it evaporates more or less rapidly at ordinary 
temperatures, and when moderately heated it sublimes without 
leaving a residue. 



ANTISPASMODICS. 



401 



From camphor may be obtained a number of interesting com- 
pounds, such as camphoric acid; cymol, etc. The drug should be 
kept in well-closed vessels, in a cool place. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Official Preparations. 

Aqua Camphorae — Aquae Camphorae — Camphor Water (0.8 per cent.). — 
Dose, \-2 fluidounces (15-30 Cc). 

Linimfentum Camphorae — LinimSnti Camphorae— Camphor Liniment. — 
Camphor, 20; Cotton Seed Oil, 80 parts. For external use. 

Linim6ntum Saponis — LinimSnti Saponis — Soap Liniment (4.5 percent.). — 
For external use. 

Splritus Camphorae — Spfritus Camphorae — Spirit of Camphor (10 per cent.). 
— Dose, 5-40 minims (0.3-2.6 Cc). 

Tinctura Opii Camphorata — Tincturae Opii Camphoratae — Camphorated 
Tincture of Opium (0.4 per cent.). — Dose, 1-4 fluidrachms (4-15 Cc). 

Camphora Monobromata— Camphorae Monobro- 
matae— Monobromated Camphor. U. S. P. 

Origin. — Prepared by heating Camphor and Bromine, dissolving 
in Benzin, and crystallizing from hot Alcohol. 

Description and Properties. — Colorless, prismatic needles or 
scales, of a mild, camphoraceous odor and taste, permanent in the 
air, unaffected by light, and neutral to litmus-paper. Almost in- 
soluble in water ; freely soluble in alcohol, ether, chloroform, hot 
benzin, and fixed and volatile oils ; slightly soluble in glycerin. 

Dose. — 2-5 grains (0.12-0.3 Gm.). 

Acidum Camph6ricum— Acidi Camphfirici — Camphoric Acid. — Origin. — 
Obtained by the oxidation of Camphor through the action of Nitric Acid. 

Description and Properties. — White, acicular crystals, odorless, and of a weak, acid, 
and slightly astringent taste. Soluble in hot water, alcohol, ether, and fatty oils ; almost 
insoluble in cold water. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Valeriana— Valerianae— Valerian. U. S. JP. 

Origin. — The rhizome and roots of Valeriana officinalis L., an 
herbaceous perennial 2 to 4 feet (0.6-1.2 M.) high, a native of 
Europe, and cultivated to some extent in New England and New 
York. 

Description and Properties. — The rhizome varies in length be- 
tween \ and \\ inches (1-3 Cm.), and has nearly an equal diameter, 
thick, upright, subglobular or obconical, truncate at both ends, 
brown or yellowish-brown, internally whitish or pale-brownish, 

26 



402 A TEXT-BOOK OF MATERIA MEDICA. 

with a narrow circle of white wood under the thin bark. Roots 
numerous, slender, brittle, brown, with a thick bark and slender, 
ligneous cord. Odor peculiar, becoming stronger and unpleasant 
on keeping; taste camphoraceous and somewhat bitter. 

Valerian contains valerianic and other acids and a volatile oil. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Official Preparations. 

Extr&ctum Valerianae Fluidum — Extratcti Valerianae Fluidi — Fluid Ex- 
tract of Valerian. — Dose, 15-60 minims (1.0-4.0 Cc). 

Tinctura Valerianae— Tinctiirae Valerianae — Tincture of Valerian (20 per 
cent.). — Dose, 1-2 fluidrachms (4-8 Cc). 

Tinctura ValerianaeAmmoniata — Tinctiirae Valerianae Ammoniatae — Am- 
moniated Tincture of Valerian (20 per cent.). — Dose, 30-60 minims (2.0-4.0 Cc,). 

Ammonii Valerianas— Ammonii Valerianatis— Am- 
monium Valerianate. TJ. 8. JP. 

Origin. — Obtained by saturating Valerianic Acid with Gaseous 
Ammonia and crystallizing. 

Description and Properties. — Colorless or white quadrangular 
plates, emitting the odor of valerianic acid ; of a sharp and sweet- 
ish taste ; deliquescent in moist air. Very soluble in water and in 
alcohol. Ammonium valerianate should be kept in well-stoppered 
bottles. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Ferri Valerianas— Ferri Valerianatis— Ferric 
Valerianate. TJ. 8. JP. 

Origin. — Prepared by mixing solutions of Ferric Sulphate and 
Sodium Valerianate and washing the precipitate formed. 

Description and Properties. — A dark brick-red amorphous 
powder of somewhat varying chemical composition, having the 
odor of valerianic acid and a mildly styptic taste ; permanent in 
dry air. Insoluble in cold water, but readily soluble in alcohol. 
Ferric valerianate should be kept in small, well-stoppered bottles, 
in a cool and dark place. 

Dose. — 1-3 grains (0.6-0.2 Gm.). 

ZInci Valerianas— ZInci Valerianatis— Zinc Vale- 
rianate. TJ. 8. JP. 

Origin. — Obtained by evaporating hot solutions of Zinc Sul- 



ANTISPASMODICS. 403 

phate and Sodium Valerianate, the zinc valerianate crystallizing 
out. 

Description and Properties. — White, pearly scales, having the 
odor of valerianic acid and a sweetish, astringent, and metallic 
taste. On exposure to air it slowly loses valerianic acid. Soluble in 
about 100 parts of water and in 40 parts of alcohol. It should be 
kept in small, well-stoppered bottles. 

Dose. — §-3 grains (0.03-0.2 Gm.). 



Antagonists and Incompatibles. — The actions of asafetida, 
ammoniac, and camphor are opposed by arterial sedatives, acids, 
and neutral salts, while quinine, digitalis, and ergot antagonize the 
action of valerian. 

Water and aqueous solutions precipitate camphor from its alco- 
holic solution. 

Synergists. — The antispasmodics are synergistic to each other. 
They are also aided in their action by the aromatics and many of 
the gum resins and balsarrts, alcohol, ether, etc. 

These remedies are so nearly alike in their action that their 
physiological effects will here be considered as a whole, mention 
being made of any marked difference in their individual action 
should it exist. In most respects their action is similar to that of 
the volatile oils. They differ in being disagreeable to the smell, 
and on that account, perhaps, are of service in pseudo-hysterical 
affections. In the action of this group of drugs, as well as many 
of the volatile oil series, on the sympathetic nervous system, we 
have a new field for scientific investigation. It is not unlikely that 
this portion of the nervous system has many pathological altera- 
tions resulting in confused disease syndromes — indeed, there are 
those who ascribe to it many important functions. At all events 
the action of this group of drugs is worthy of more extended study 
than is usually given in the few contemptuous sentences of many 
modern text-books. 

Physiological Action. — Externally and Locally. — The only 
member of this group having any special local action is camphor. 
This drug has an anesthetic effect upon the unbroken skin, but in 
a concentrated state is very irritating to mucous membranes, and 
may even produce inflammation and sloughing. Camphor is also 
a powerful parasiticide. 

Digestive System. — In medicinal doses antispasmodics stimulate 
the digestion and augment the secretions from the gastro-intcstinal 



404 A TEXT-BOOK OF MATERIA MEDICA. 

tract. They also stimulate peristalsis, and are active carminatives 
and calmatives to the digestive tract. Asafetida is the most laxa- 
tive of all. 

Large doses of any antispasmodic cause nausea, Vomiting, and 
purging, camphor being the most irritant, and in toxic doses acting 
as an irritant poison. 

Circulatory System. — In medicinal doses the antispasmodics in- 
crease the force of the heart and elevate arterial tension. 

Asafetida exerts the greatest influence on menstruation, while 
camphor has the most marked effect upon the general circulation. 

Nervous System. — It is probably upon the nervous system that 
these drugs exert their most potent action. They are all stimu- 
lants to some portion of the cerebrum. Their precise influence 
upon the brain is, however, unknown, and in order to form a better 
conception of the action of these drugs some explanation of the 
function of the brain is necessary. 

The cerebrum consists of a complex mechanism, each localized 
area having a definite physiological function, the relations of the 
several areas differing one from another, some being equal and 
others subordinate. These areas probably are — 1. Perception areas 
— five ; 2. Judgment areas ; 3. Emotion areas ; 4. Motor areas ; 
5. Inhibitory areas. These areas are all connected by commissural 
fibers. 

The emotion and motor areas are controlled by the functional 
influence of the areas of inhibition. Sometimes disturbing influ- 
ences modify this adjustment, so that the lower areas act inde- 
pendently. The perturbation may be due either to deficient power 
of inhibition, to unusual activity of the lower areas, or to lack of 
co-ordination in the connecting fibers by which the unimpeded areas 
are held in subjection. Even a slight loss of command occasions 
in the subject an irritability readily aroused, together with annoy- 
ance from trivial causes which under normal conditions would be 
inconsequential. The mental derangement accompanying these 
phenomena we call nervousness, and when the symptoms become 
still further aggravated the mental disturbance known as hysteria 
results. 

Again, the emotion and cerebral motor areas may become so 
far freed from restraint that even violent hysterical symptoms ensue, 
including convulsions or coma. Obviously, therefore, the only 
remedy for the malady is to restore the equilibrium between the 
inhibitory and lower areas. 



ANTISPASMODICS. 405 

This may be effected either by stimulation of the debilitated 
areas of inhibition, by depression of the over-active lower areas, or 
by supplying a possible deficiency in the conductive force of the 
fibers. The first of these desiderata may be attained by improving 
the circulation and affording stronger nutriment. By dilating the 
arterioles small doses of alcohol and ether accomplish this object, 
and may act favorably in an attack of hysteria. Alcohol, however, 
in large doses exerts a deleterious influence by causing exceeding 
depression of the central nervous system, resulting in incoherence. 
Arsenic, quinine, cod-liver oil, and iron by their tonic effects may, 
under continued dosage, abort access of hysteria. 

Other remedial agents which tend to act directly upon the cell- 
ular structure of the inhibitory areas, and thereby invigorate them, 
are the drugs under consideration — the antispasmodics. By stim- 
ulation of the inhibitory centers they may allay the spasms of 
hysteria. 

The morbid activity of the lower areas may be ameliorated by 
depressant remedies, among which morphine and the bromides may 
prove particularly beneficial. 

The antispasmodics, it will be seen, appear to exert a calmative 
influence upon certain nerve-centers, allaying nervous excitement 
and muscular spasm. They produce a gentle, exhilarating effect 
upon the brain, and diffuse a feeling of warmth in the system. It 
is claimed that they also possess mildly aphrodisiac properties. 
Excessive doses, on the other hand, may occasion delirium, even 
merging in maniacal excitement, this being particularly true of 
camphor, toxic doses of which drug, in the monobromated form, 
cause muscular weakness, passing into paralysis, followed by stupor 
and collapse. Valerian may occasion formication of the hands 
and feet and a condition of melancholia. 

Respiratory System. — The antispasmodics are all respiratory 
stimulants and stimulant expectorants. Large doses of mono- 
bromated camphor depress respiration. 

Absorption and Elimination. — These drugs are readily absorbed 
from the stomach or rectum, and are eliminated by the intestinal 
tract, kidneys, lungs, skin, and mucous membranes generally, stim- 
ulating the glands in these structures, and, in the case of asafetida 
and valerian, imparting the characteristic odor of these drugs to 
the excretions. 

Temperature. — Unaffected except by monobromated camphor, 
which in large doses acts as a depressant. 



406 A TEXT-BOOK OF MA TERIA MEDICA. 

Uterus. — The menstrual flow and sexual appetite are increased 
at first ; continued dosage, however, has a depressing effect upon 
the generative functions, camphor perhaps being the most active 
in large doses. 

It is said that the sexual passion of cats is extraordinarily 
excited by valerian, probably because of its odor. 

Untoward Action. — Camphor may occasion mental confusion, 
headache, vertigo, dryness of the mouth and thirst, flushing of the 
face, clammy perspiration, disturbances of digestion, and strangury. 
Musk produces similar untoward manifestations, with a sense of 
pressure in the eye-sockets and marked sexual excitement. The 
symptoms caused by valerian are very much the same, although, 
as in the untoward action of asafetida, there is more disturbance 
of the gastro-intestinal tract, such as nausea, borborygmi, diarrhea, 
and colicky pains. Barbier noted visual hallucinations in a person 
treated with valerian. 

Poisoning. — The symptoms of poisoning resemble the untoward 
action, save that the effects may be more marked, with greater 
irritation of the intestinal tract and more pronounced cerebral 
disturbance. 

Treatment of Poisoning. — Coffee and the arterial sedatives an- 
tagonize the action of camphor. The patient should be treated 
symptomatically ; emetics or the stomach-pump should be employed, 
and measures taken to favor elimination. Excessive nervous mani- 
festations may be controlled by opium or the bromides. 

Therapeutics. — Externally and Locally. — The only member of 
the present group used locally is camphor, its anesthetic and anti- 
pruritic properties rendering it of great value in the treatment of 
diseases of the skin. "Anderson's powder," composed of pulver- 
ized camphor, starch, and zinc oxide, is a very soothing and 
efficient dusting powder in erythema, erythematous eczema, and urti- 
caria. " Camphor-ice " and ointments of camphor, alone or com- 
bined with salicylic acid, are used for " chapped hands" ulcers, etc. 

Various inhalants and powders containing camphor have been 
successfully employed in the treatment of ozena, acute coryza, and 
laryngitis. Suppositories of camphor afford great relief in cases 
of chordee, while the camphor liniment is a household remedy for 
sprains, bruises, chilblains, etc. 

Camphor chloral makes an efficient local application in neur- 
algia, and the campho-phenique is an excellent antiseptic, when 
mixed with oil being an efficient dressing for wounds. 

Internally. — The disagreeable odor and taste of many of the 



ANTISPASMODICS. 407 

antispasmodics — notably asafetida, valerian, and musk — greatly 
limit their use. Asafetida is an exceedingly valuable stomachic 
tonic, and singularly beneficial in the atonic dyspepsia and constipa- 
tion of nervous and anemic women. It stimulates the appetite and 
digestion, acts as a laxative, and allays much of the nervousness 
and melancholia from which these patients so frequently suffer. 

Asafetida is a peculiarly potent remedy in relieving parox- 
ysms of hysteria, and there is probably no more effective agent 
for the alleviation of flatulent colic of infants and various infantile 
convulsions. 

Chronic bronchitis and bronchorrhea, especially when attended 
with spasmodic dyspnea, are very favorably influenced by this rem- 
edy. Its antispasmodic action renders asafetida of considerable 
value in whooping cough and the sympathetic cough of mothers. 
The drug has been highly recommended in chorea occurring in 
young girls about the age of puberty, who are weak, anemic, and 
suffering from menstrual irregularities. The emulsion of asafetida, 
used as an enema, often affords prompt and complete relief in the 
tympanitis of typhoid fever. 

Ammoniacum is chiefly employed as a stimulant expectorant in 
chronic bronchitis. Camphor is a remarkably efficient anodyne, an- 
tispasmodic, and carminative in flatulent colic, diarrhea of infants, 
and the diarrhea of the aged produced by relaxation of the bowels. 
For many years camphor has been considered a valuable remedy 
in the diarrhea ushering in an attack of Asiatic cholera. 

The various spasmodic and hysterical disorders for which asa- 
fetida is recommended are also greatly benefited by camphor. It 
is, moreover, a serviceable stimulant expectorant and a potent 
remedy, especially monobromated camphor, to allay sexual excite- 
ment and for the relief of chordee. It has likewise proved effica- 
cious in spermatorrhea. 

Mania, especially the puerperal form, delirium tremens, and 
melancholia have occasionally been benefited by full doses of 
camphor. The internal use of the drug has appeared to prove 
beneficial in senile gangrene. 

Dysmenorrhea and the after-pains of labor are greatly relieved 
by camphor, either alone or combined with morphine. The drug 
has been used extensively as a cardiac stimulant and to allay the 
delirium and restlessness of typhoid, typhus, and exantJiematous fevers. 

Camphoric acid is an efficient remedy in checking the night- 
sweats of phthisis and excessive perspiration in acute rheumatism. 
It is recommended by Wood in enuresis and spermatorrhea. While 



408 A TEXT-BOOK OF MATERIA MEDICA. 

not so efficient as camphor or monobromated camphor in spas- 
modic and hysterical disorders, it has proved of some benefit in 
these conditions. 

Camphoric acid in from i to 2 per cent, solution is useful in 
the treatment of acute pharyngitis and acute coryza, being employed 
in the form of a gargle or spray. 

Camphoric acid has been used internally to acidify ammoniacal 
urine in cystitis. 

Valerian has been employed for the same class of disorders as 
those treated with asafetida, but seems to be superior to the latter 
in mitigating the hysterical manifestations and vaso-motor disturb- 
ances occurring at the menopause. 

The hypochondriasis of feeble and morbidly sensitive girls and 
women is usually soon relieved by this remedy. Nervous headache 
and vertigo due to cerebral anemia and the irregular distribution 
of blood are, in the majority of cases, promptly relieved by valerian 
or the ammonium valerianate. 

Valerian has been favorably recommended in both diabetes 
insipidus and mellitus. 

Contraindications. — There are no special contraindications to 
the use of antispasmodics other than in acute inflammations of the 
gastro-intestinal tract, when camphor should not be employed. 

Administration. — Any of the preparations of the various mem- 
bers of this group may be used. Asafetida and camphor in sub- 
stance should always be given in the form of pills or capsules. 
Camphoric acid is best administered in capsules. 



GROUP II.— ANTIPYRETICS. 

Acetanilldum 1 — Acetanilldi— Acetanilid. 

Origin. — An acetyl derivation of Aniline. 

1 Antifebrin is a copyrighted name for Acetanilid, or Phenyl-aceiamide, as it is some- 
times called. The copyrighted word Antifebrin should never be used. The proprietary 
preparations like Antikamnia, Antinervin, Phenolyd, Exodyne Ammonol, etc. are said, 
by different chemists who have analyzed them, to be mechanical mixtures of Acetanilid 
and one or more such substances as Sodium Bicarbonate, Caffeine, Ammonium Bromide, 
Salicylic Acid, Sodium Salicylate, etc. Such secret preparations should not be counte- 
nanced by medical men. Should a combination containing some of the aforesaid drugs 
be desired, a prescription for the same should be written, specifying the proportions 
wanted in each particular case, rather than prescribe a proprietary article costing a 
dollar or more an ounce, the same mixture being put up by any pharmacist for ten 
cents an ounce. 



AN TIP YRE TICS. 409 

Description and Properties. — White, shining, micaceous, crys- 
talline laminae, or a crystalline powder, odorless, faintly burning 
taste, permanent in air, neutral to litmus-paper. It is soluble, at 
1 S° C. (59 F.), in 194 parts of water, 5 parts of alcohol, 18 parts 
of boiling water, and in 0.4 part of boiling alcohol; also in 18 
parts of ether, and easily soluble in chloroform. 

Dose. — 2-10 grains (0.1-0.65 Gm.). 

Physiological Action. — Externally and Locally. — Antiseptic, 
slightly sedative. 

Internally. — Digestive System. — Non-irritating, sedative ; medic- 
inal doses sometimes allay nausea. 

Circulatory System. — In therapeutic doses acetanilid appears to 
have no action upon the blood. The corpuscles are unaffected 
under the influence of small doses, but toxic doses disorganize the 
corpuscles. When large doses are taken, or even small doses by one 
who has an idiosyncrasy against the drug, the arterial blood becomes 
venous in character, the normal alkalinity of the blood is decreased, 
and much of the hemoglobin is reduced to methemoglobin. 

This action as a disorganizer of the blood is the property more 
particularly of the aniline compounds ; the phenetidines have less 
of it, and antipyrine and its congeners show it to the least extent, 
or such action is entirely absent. 

Heart and Blood-vessels. — In medicinal doses the arterial ten- 
sion is slightly raised, while the heart is slowed. Toxic doses 
directly depress the heart and vaso-motor mechanism, causing an 
immediate fall of arterial pressure and great cardiac depression. 

Nervous System. — In medicinal doses acetanilid is a sedative to 
the sensory nerves and spinal cord. Small doses are mildly stim- 
ulant to the brain, and under certain conditions the drug is a 
hypnotic. Toxic doses result in general anesthesia and abolition 
of reflexes, with paralysis of motor and sensory nerves. 

Respiratory System. — Medicinal doses produce no special effect. 
When toxic doses are given there is a rapid and labored respiration. 
Death is produced by respiratory failure, due to direct action of the 
drug upon the respiratory center, and indirectly by greatly de- 
creasing the oxygen-carrying power of the blood and by paralyz- 
ing the peripheral motor nerves. 

Absorption and Elimination. — Acetanilid is an active diuretic, in- 
creasing the excretion of urea, and to some extent the excretion of 
uric acid. After toxic doses have been taken the urine becomes dark 
or brownish in color, from the presence of disorganized corpuscular 



410 A TEXT-BOOK OF MATERIA MEDICA. 

elements of the blood. It is diaphoretic. Acetanilid is chiefly elim- 
inated by the kidneys in the form of sulphate of para-amido-phenol. 
Temperature. — Acetanilid has little or no effect on the normal 
body temperature ; but if the latter is above normal, the drug has 
a marked antipyretic action, often reducing the temperature to 
below normal. This peculiar effect of acetanilid, and of the phe- 
netidine group in general, is due primarily to the action of the 
drug on the heat-center in the medulla. When the body is in a 
state of hyperpyrexia the heat-center is in a depressed condition, 
owing to certain poisons circulating in the blood, and will not 
respond to the normal limit (98. 6°) of body temperature. Acetani- 
lid increases the irritability of the heat- center, causing it to respond 
to a lower temperature, and, through its action on the vasomotor 
center, stimulates the vasodilators, thereby augmenting the periph- 
eral circulation, with consequent increase of heat-dissipation. 

Eye. — Medicinal doses have no apparent influence on the eye. 
Toxic doses have produced contracted and motionless pupils. 

Untoward Action. — Under prolonged use of acetanilid conges- 
tion of the liver, kidneys, and spleen occurs. Paroxysms of 
sneezing have apparently been induced by a medicinal dose, and, 
under the same, redness of the skin, chilliness, and cyanosis have 
sometimes ensued. 

Poisoning. — The skin is cyanosed, the face is livid and anxious, 
and the body is covered with cold sweat. There may be vomiting ; 
the pulse is soft, slow, and weak, accompanied by profound pros- 
tration. The respirations are first rapid and labored, and later slow 
and very shallow, death resulting usually from respiratory paraly- 
sis. After death the heart, liver, and kidneys are found in a state 
of acute fatty degeneration. 

Treatment of Poisoning. — Diffusible stimulants, like alcohol, in 
small doses, ammonia, and sulphuric ether. Coffee, atropine, and 
strychnine hypodermically as circulatory and respiratory stimu- 
lants. External heat and, if necessary, oxygen inhalations to over- 
come cyanosis. 

Therapeutics. — Externally and Locally. — Acetanilid has been 
locally applied for the treatment of chancre and chancroid, but there 
are other antiseptics which are generally considered to be more 
satisfactory. It is quite an active hemostatic, and may be used in 
epistaxis and hemoptysis. 

Internally. — The use of acetanilid in fevers has been practically 
abandoned by the great majority of clinicians. If an antipyretic 



ANTIPYRE TICS. 41 1 

of this character is indicated at all, it is in stJienic fevers, and then 
to be used only with great care. Its tendency to cause cardiac 
depression, profuse sweating, and collapse renders its use harmful, 
if not unsafe, in low conditions like typhoid fever and advanced 
phthisis. It may often be administered with good effect in the first 
stage of pneumonia. The headache, fever, and other unpleasant 
symptoms in the exanthemata are greatly modified by its use, 
although when this drug is given to children they must be very 
carefully watched to avoid untoward effects. 

There is considerable difference of opinion in regard to the utility 
of acetanilid in rheumatism. Some authorities believe that it exer- 
cises a most favorable influence in the acute articular variety, being 
less apt to disturb the brain than salicylic acid or its salts. The 
drug certainly mitigates, and often entirely relieves, the pain and 
swelling, while it reduces the fever. Like salicylic acid, it has no 
power to prevent heart-complications, but, on the contrary, it 
should be used with great care, if at all, when such complications 
exist. It has no tendency to prevent relapses. 

The dose of acetanilid in acute rheumatism should not exceed 6 
grains (0.5 Gm.) three times a day. 

Acetanilid is a very efficient analgesic, and the introduction of 
this drug, antipyrine, and other remedies of this character has 
enabled us to relieve the pains of certain spinal diseases more 
efficiently than was possible before. 

The crises of locomotor ataxia are often promptly relieved by 
acetanilid. Neuralgias of every kind indicate its use. The pains 
of neuritis, lumbago, gastralgia, dysmenorrhea, sciatica, tabes dor- 
salis, and nearly every kind of headache usually yield to its anal- 
gesic influence. 

In many cases of chorea and epilepsy (especially the diurnal 
variety), and in those cases characterized by full habit and high 
arterial tension, the drug has often been employed successfully. 

Pains which are paroxysmal in character yield best to acetanilid. 
It quiets the excitement in mania a potu, and frequently lessens the 
paroxysms of ivhooping-cough. 

In doses of 3-5 grains (0.2-0.32 Cc), thrice daily, acetanilid has 
proved efficient as a relief for sea-sickness. It has also been found 
serviceable in traumatic tetanus. 

The author has found it to be of great value in influenza, or " la 
grippe" combined or given alternately with salol or sodium salicy- 
late. It is also highly praised in acute bronchitis. 



412 A TEXT-BOOK OF MATERIA MEDIC A. 

Contraindications. — In low fevers, at any rate not in repeated 
doses ; in fatty or dilated heart, blood disorders, advanced tuber- 
cular disease, and exhaustion from hemorrhages. 

Administration. — It may be prescribed in powders, pills, com- 
pressed tablets, capsules, or alcoholic solution. A speedier effect 
is produced if it is taken dissolved in a small quantity of alcohol or 
wine diluted with water. 

The average dose as an antipyretic usually should not exceed 5 
grains (0.3 Gm.) ; as an anodyne, 2-5 grains (0.1-0.3 Gm.). It 
may be repeated at intervals of about four hours or less, according 
to its effects. 

Its action in neuralgias, according to Hare, may be assisted by 
associating it with small doses of monobromated camphor. 



Antipyrlna— Antipyrlnae— Antipyrine. 

Origin. — A Coal-tar derivative. 

Description and Properties. — A white, crystalline powder, 
odorless, of a slightly bitter taste, freely soluble in water, alcohol, 
and chloroform. 

Dose. — 3-20 grains (0.19- 1 3 Gm.). 

Antagonists and Incompatibles. — Antipyrine is incompatible 
with spirit of nitrous ether and nitrous compounds, the chlorides 
of mercury, the iodides of arsenic and mercury, the ferric salts in 
solution, tincture of iodine, most of the vegetable astringents, car- 
bolic acid, chloral, beta-naphtol, sodium bicarbonate, sodium salicy- 
late, and the salts of quinine and caffeine. 

Synergists. — The same as for other members of this group. 

Physiological Action. — Digestive System. — Antipyrine differs 
from acetanilid in that it often produces vomiting. 

Respiratory System. — In medicinal doses it increases the number 
of respiratory movements. In every other respect it has the same 
action upon the respiration as acetanild. 

Absorption and Elimination. — Kidneys. — Antipyrine lessens the 
amount of urine, urea, and uric acid excreted, but increases the 
amount of sulphuric acid in the urine. Like acetanilid, toxic doses 
cause the urine to assume a dark or brownish color. It is more rap- 
idly eliminated than acetanilid, being detected in the urine within 
three hours after being taken. 

Eye. — Toxic doses have produced amblyopia and hallucinations 
of vision. 



AN TIP YRE TICS. 4 1 3 

Therapeutics. — The remarks on the therapeutics of acetanilid 
are applicable to this drug, although antipyrine is a more powerful 
antiseptic, analgesic, and local anesthetic. As an analgesic it prob- 
ably ranks next to opium. The anesthesia produced by antipyrine 
often lasts for several hours or even days. In acute coryza and 
inflammation of the pharynx great relief is obtained by spraying 
the parts with a 2 or 4 per cent, solution, after applying a solution 
of cocaine to prevent the primary smarting and irritation which the 
antipyrine produces. 

A 20 per cent, solution has been used in otitis, and a 4 per cent, 
solution has been found very efficient in cystitis. 

Antipyrine has been used with some success in diabetes mellitus 
and malarial diseases, particularly in intermittent fever. It does not, 
however, possess the antiperiodic and specific action of quinine in 
malarial poisoning. It is an excellent antispasmodic in whooping- 
cough, laryngitis, and asthma. 

Administration. — The drug is best given in water or some 
aromatic water or syrup. It may also be given hypodermically. 
In hemorrhage the powdered drug may be applied locally, or a 
40 per cent, solution, which causes less irritation. From \- 2 
grains (0.03-0.12 Gm.), once or twice a day, is sufficient for 
children. Ordinarily a dose of 5 grains (0.3 Gm.) is sufficient 
for an adult. 

Phenacetin. 

Origin. — A Coal-tar derivative. 

Description and Properties. — A colorless, odorless, tasteless 
powder, or glistening, scaly crystals, sparingly soluble in cold 
water, more or less soluble in boiling water, and freely soluble in 
16 parts of rectified spirits. 

Dose. — 1 -10 grains (0.06-0.6 Gm.). 

Physiological Action. — Phenacetin differs from acetanilid only 
in the following respects : 

Circulatory System. — Small doses increase the force of the heart, 
accelerate the pulse, and raise arterial tension. Large doses affect 
the blood and the circulatory system like acetanilid. 

Kidneys. — It is a diuretic, but not so active as acetanilid. When 
large doses have been taken the urine is dark-yellow in color and 
gives the reaction for sugar. 

As an antipyretic phenacetin is said to be slower in its action 
than acetanilid, nor is it so powerful as an analgesic and hypnotic. 



414 A TEXT-BOOK OF MA TERIA MEDICA. 

By many physicians the drug- is considered one of the safest 
of the synthetical antipyretics. It has an advantage over many 
other antipyretics in being tasteless, seldom exciting nausea, exces- 
sive diuresis, diaphoresis, or diarrhea. The author's experience 
leads him to consider it as possessing a briefer antithermic action 
and a greater tendency to produce cyanosis and rigors than ace- 
tanilid or antipyrine. 

Therapeutics. — Phenacetin is given in the same class of diseases 
as acetanilid. 

Contraindications. — The same as for acetanilid. 

Administration. — The drug maybe dispensed in powders, pills, 
capsules, tablets, or suspended in mucilaginous drinks. 1 

Phenocoll. 

Origin. — A combination of Para-amido Phenocoll and Glycocoll. 
The phenocoll hydrochloride is the salt used in medicine. 

Description and Properties. — A white crystalline powder, sol- 
uble in 1 6 parts of water, and freely soluble in hot alcohol, forming 
a neutral solution- 
Dose. — 3-15 grains (0.2-1.0 Gm.). 

Incompatibles. — All the alkalies. 

Physiological Action. — Phenocoll differs from acetanilid in no 
essential particulars other than the following : 

Circulatory System. — Its effect upon the heart and pulse is sim- 
ilar to that of acetanilid, but it has less influence upon the blood 
itself. 

Kidneys. — The excretion of nitrogen in the urine is increased. 

Temperature. — In febrile conditions it produces a decided fall 
of temperature within one hour after its administration by the 

1 Phenacetin may be adulterated with phenacetidin, a by-product in manufacture and 
a poisonous substance, which in small doses induces kidney trouble. Many of the toxic 
symptoms of acetam'Hd so closely resemble aniline-poisoning as to suggest the production 
of that substance in the blood. There, is a close relationship between the two bodies, 
and there is some ground to suspect the occasional presence of aniline in samples. The 
important question of adulteration and impurity should not be lost sight of in consider- 
ing the ill effects of any drug. In the experience of the author, better results, in every 
particular, have been obtained from antipyrine than from either of the other antipyretics 
mentioned, so that he almost invariably uses it, both for adults and children, believing it 
the safest drug of its class, as well as the most certain and uniform in its action. 

These drugs are unquestionably given in too large doses by the majority of physi- 
cians, and persons suffering from high temperature are more susceptible to their untoward 
influences — like cyanosis, collapse, etc. — than those whose temperature is normal. 



ANTIPYRETICS. 415 

stomach, caused by an enormous diminution of heat-production 
without any marked alteration of heat-dissipation. 

Therapeutics — Experience with phenocoll hydrochloride is yet 
too limited for us to draw any trustworthy conclusions as to its 
safety compared with the antipyretics previously mentioned or re- 
garding its real place in medicine. The results, thus far, have shown 
it to be comparatively safe — probably the safest of all antipyretics — 
and of value internally for all conditions benefited by the previously 
named antipyretics. It is not so valuable an antipyretic and anal- 
gesic in rheumatism as acetanilid or antipyrine, nor is it so efficient 
an analgesic in myelitis, sciatica, or neuralgia ; but, on the other 
hand, it far surpasses these drugs in the treatment of intermittent 
fever, ranking next to quinine in malarial disorders. 

Pelletini, indeed, regards it as superior to all antimalarial reme- 
dies, and Bonetti considers it a real substitute for quinine. 

Phenocoll possesses the advantage of not producing the un- 
pleasant effects of quinine. It is a powerful antiseptic, and may 
be applied locally where a drug of that character is indicated. 

Contraindications. — Probably the same as for acetanilid. 

Administration. — Locally, the drug may be employed in solu- 
tion or in the form of an ointment in strengths varying from 5 to 
20 per cent. Internally it may be administered, in the doses recom- 
mended, from three to five times a day, in powders, aqueous solu- 
tion, or in capsules. 



Exalgine (Methylacetanilide). 

Origin. — As the chemical name indicates, this substance is 
a derivative of Acetanilid. 

Description and Properties. — Exalgine occurs in colorless 
needles or prisms, inodorous and tasteless. It is neutral to test- 
paper, and is freely soluble in alcohol, chloroform, carbon disul- 
phide, and boiling water. It requires about 60 parts of cold water 
or 10 parts of ether for solution. 

Dose. — 2-4 grains (0.1-0.2 Gm.). 

Antagonists and Incompatibles. — Exalgine is incompatible 
with the iodides, salicylic acid, and solution of potassa. 

Synergists. — All members of this group, as well as opium, 
cocaine, belladonna, and hyoscyamus. 

Physiological Action. — Exalgine is almost identical in its action 
with acetanilid, with the exception that it possesses less antipyretic 



^.i6 A TEXT-BOOK OF MATERIA MEDICA. 

power. In medicinal doses the drug increases arterial tension, and 
in full doses profoundly affects the cerebro-spinal axis. It is more 
uncertain than, and not so safe as, either of the drugs previously 
mentioned. 

Therapeutics. — Exalgine should never be employed as an anti- 
pyretic, but as an analgesic it may be given for the same purposes 
as acetanilid and antipyrine. Good results have been reported in 
the treatment of chorea by this drug. 

Contraindications. — The same as for other agents of this group, 
and, in addition, fever, it is said, contraindicates its use. 

Administration. — Exalgine may be administered either in pow- 
ders or capsules, but the doses should not be given at frequent 
intervals, from six to seven hours elapsing between them, and only 
in exceptional cases should more than 10 grains (0.16 Gm.) be 
given in twenty-four hours. 

The labors of the synthetic chemist and his pharmacological 
confreres have resulted in the manufacture and proving of a large 
series of allied bodies, a brief mention of which is here included. 
In general their action is similar to those already mentioned, but it 
is important to note that in the substitution of some radicle for 
others, important differences in the physiological actions of the 
product may result. Thus, some unpleasant by-effect may be 
eliminated, or the taste improved, or the solubility modified, or, 
even more important, a radical action on the blood or nervous 
tissues modified. A study of the individual substituted radicle is 
important, therefore, in the interpretation of the result. Such 
details are out of place here, but it may be added that the pharma- 
cology of the future is to concern itself more and more in the cor- 
relation of chemical structure and physiological action. No more 
important sign of the times can be mentioned than the appearance 
of much research along this line. S. Frankel's Arzneimittel Syn- 
these is to be recommended to those students who would under- 
stand the drift of modern drug study in this particular. 

Some of the more important drugs of this class are : 

Methacetin, which is practically the same as phenacetine, save 
that a methoxyl group has been substituted for an ethoxyl group 
in that compound. It is simpler in its composition than phenace- 
tine, and hence, according to Harnack's theory, is more poisonous. 
That observer holds that the more complex the side chain addi- 
tions to the original phenetidine nucleus, the longer it takes the 
new body to act, and, therefore, the less poisonous is it. 



ANTIPYRETICS. 417 

Other phenetidine bodies are : 

Lactophenin, in which a lactyl derivative is added to pheneti- 
dine. It is more soluble than phenacetine, and the lactyl group is 
supposed to add some hypnotic action. 

Saliphcnin is too weak to be of any service. 

Citrophcn and Apolysin are combinations of citric acid and phe- 
netidin. The citric acid radicle was added for its stimulating effect 
on the heart, and hence these two are reputed to overcome the 
phenetidin depressing effect on this viscus. The action, however, 
clinically, cannot be detected from that of phenacetin, and, more- 
over, there are certain objections, in the way of the splitting of 
these compounds in the stomach, which render them less suitable 
than phenacetine. 

Salicylphenetidin was devised to combine the antirheumatic and 
antipyretic factors, but it appears that this compound is too stable 
and does not break up into its constituents, and is found in the 
urine in its original form. 

Malakin is somewhat similar to the former drug. It breaks off 
a phenetidin, however, but is very slow of action and requires large 
doses to reduce the temperature. 

Salocoll is similar to phenocoll. 

Phesin is a new sulphur compound with phenacetin, in which 
the sulphur radicle reduces the blood-toxic action, but inasmuch as 
it does not form amidophenol in the body, which substance is the 
main antipyretic agent, it has been abandoned. 

It is important that a certain grouping of the antipyretics may 
be made. Schmitt 1 has done this along lines referring to their 
activities on the respiratory capacity, and of their action on the 
oxyhemoglobin of the blood. He makes five classes : (1) Those 
antipyretics that, in medium-sized doses, serve only to more or less 
fix the oxygen of the hemoglobin — antipyrin, phenacetin. 

(2) Those that, in large doses, bring about an intracorpuscular 
methemoglobinuria — thallin, antithermin, kairin, exalgen, methace- 
tin, acetylamidophenol. 

(3) Those that produce methemoglobin and also induce the 
destruction of the red blood-cell — acetanilid, benzanilid, formani- 
lid, methylformanilid, and pyrodin. 

From this it appears that antipyrin and phenacetin are to be 
most trusted. 

1 See Frankel, Arzneimittel Synthese ; also Coblentz, "Chemical Action and Physi- 
ological Action of Drugs," American Journal of Pharmacy y September, October, 1901. 

27 



418 A TEXT-BOOK OF MATERIA MEDICA. 

GROUP III— ANESTHETICS. 

As heretofore defined, these are substances having the property 
of destroying sensation, or producing anesthesia, either general or 
local. 

To Dr. Oliver Wendell Holmes is due the credit of proposing 
the term "anesthetic." This group naturally occupies the place 
between the preceding one and the next — Hypnotics. As before 
stated, there exists a close chemical relationship between antiseptics, 
antipyretics, anesthetics, hypnotics, and analgesics. The first two 
of these possess marked anesthetic and analgesic properties. The 
drugs included in the present group should properly be classed as 
general anesthetics, possessing more nearly the characteristics of 
typical anesthetics. 

We quote the following, from F. Lauder Brunton's Introduction 
to Modern Therapeutics : 

" The use of drugs to abolish pain in surgical operations has 
probably never been entirely forgotten, but their general and sys- 
tematic employment only commenced with the use of nitrous oxide 
by Wells, in 1844, and of ether by his pupil Morton. Shortly 
afterward a great number of substances were tried by Simpson, 
with the result that he chose chloroform as being the most con- 
venient and safe. The power of producing anesthesia, or perhaps 
I should say, more definitely, the power not only to abolish pain 
and thus render an operation unfelt by the sufferer, but to abolish 
reflex action, so that the surgeon may be able to operate more 
easily, is common to most of the substances of the fatty or alco- 
holic series. But it is greatly modified by two circumstances : (1) 
the position in the fatty or alcoholic group of the radical or alkyl 
which forms the basis of the substance ; and (2) the nature of the 
element or radical with which the alkyl is combined .... Thus in 
the case of the alkyls, their action diners according as they are 
combined with hydrogen in the hydrides, with hydroxyl, OH, in 
the alcohols, or with both oxygen and hydroxyl, as in the acids. 

" Moreover, both their physical condition and physiological 
action may be changed by replacing hydrogen by other elements. 
Thus, if we replace three atoms of hydrogen in marsh-gas, CH 4 , 
by chlorine, which has an atomic weight of 35.5, while that of 
hydrogen is only I, we convert the light gas with a molecular 
weight of 16 into the heavy liquid chloroform, with a molecular 
weight of 1 19.5. If in place of three atoms of chlorine, we intro- 
duce three of iodine, each having a weight of 127, the molecular 
weight of the whole compound becomes 394, and in place of a 



ANES THE TICS. 4 1 9 

permanent gas like marsh-gas, or a heavy fluid like chloroform, 
we get a solid like iodoform. 

" The physical condition of the substance may be influenced by 
the number of atoms of other elements which combine with an 
alkyl as well as by their nature. Thus, when only one atom of 
hydrogen in methane, CH 4 , is replaced by chlorine, the resulting 
monochlormethane, CH 3 C1, or methyl chloride, is a gas at ordinary 
temperatures, although it can be condensed by cold and pressure 
to a liquid which boils at 22° C. Dichlormethane, or methylene 
chloride, CH 2 C1 2 , is a heavy liquid boiling at 41 ° C. ; and trichlor- 
methane, or chloroform, CHC1 3 , is a still heavier liquid, which 
boils at 61 ° C. It appears, then, that we can increase the atomic 
weight of an anesthetic and render it more solid by adding carbon 
to the alkyl, or by replacing hydrogen with heavier atoms like 
chlorine or iodine. The more hydrogen atoms are thus replaced 
the denser does the body become, so that it may pass from a gas 
to a liquid, and then to a solid at ordinary temperatures. 

" It is probable, as I have said, that all the substances belonging 
to the alcoholic series possess the power of abolishing to a greater 
or less extent the excitability of all the nerve-centers within the body. 
They appear to act upon those centers in the inverse order of their 
development, destroying first the functional activity of the highest 
ideational and volitional centers in the cerebrum, those centers 
which are the latest to be developed, and which not only raise man 
above the animals, but raise individual men above their fellows. 
As their action increases, nerve-centers of a lower development are 
affected, or, as Hughlings Jackson puts it, the most highly organ- 
ized centers are affected first, while the lowest, most simple, and at 
the same time most automatic and stable centers are affected last. 
The perceptive and motor ganglia, the reflex centers of the cord, 
the vasomotor and respiratory centers, and the heart, all become 
paralyzed when the action of the members of this group is pushed 
to its utmost extremity. 

(i But they are not all rendered inactive in the same order by 
each member of the group. On this account some members are 
useful as hypnotics, simply inducing sleep as one of the first results 
of their action; although if the dose be large, the sleep may pass 
into complete unconsciousness or anesthesia, with loss of reflex 
action. For the production of prolonged sleep we require a sub- 
stance whose action will be slight, and at the same time prolonged ; 
but for anesthesia we require a substance that will act rapidly 
and powerfully, but will be quickly eliminated and cease to act 



420 A TEXT-BOOK OF MATERIA MEDICA. 

very shortly after its administration is discontinued. We therefore 
look for hypnotics among the substances which have a heavy 
molecule, and are either liquid or solid in form, so that they may 
be given by the mouth, and being absorbed into the blood continue 
to act for a length of time. We look for our anesthetics amongst 
the lower members of the series which have a light molecular 
weight, and are either gases or volatile liquids. Although heavy 
liquids like paraldehyde, or solids like chloral hydrate, will act as 
anesthetics when given in large doses, yet their use as such would 
be very dangerous, for the line between their anesthetic action and 
their paralyzing action on the respiratory center is very narrow, 
and might easily be crossed by very slight excess in dose. The elimi- 
nation of such substances being slow, we cannot at once get rid of 
their effects of excess in the same way as we can in the case of those 
which, like ether, enter the lungs as vapor and are readily eliminated." 

An ideal agent of this description should be a substance capable 
of rapidly and safely producing profound anesthesia, and susceptible 
of speedy elimination, so that consciousness may be restored soon 
after withdrawal of the anesthetic, with no discomfort to the patient. 

The typical anesthetic should also be convenient and safe — 
a stable, non-irritating, pleasantly odorous, homogeneous liquid, 
with a boiling-point neither too high nor too low. Unfortunately, 
there is no substance which fully meets these requirements, ether 
and chloroform approaching nearest to the ideal agent. 

The general anesthetics, with the exception of nitrous oxide, 
all belong to the class of alcohols and ethers. Indeed, alcohol, 
although in this work not classed among anesthetics, possesses 
marked anesthetic properties, as well as others — antiseptic, anti- 
pyretic, etc. — characteristic of these drugs. 

It has been stated by Dr. Richardson that the first recorded 
case of the use of an anesthetic in surgery was that of Dr. Collier 
in 1839, who anesthetized his patient by causing him to inhale the 
fumes of alcohol. 

It has been well known for centuries that alcohol, when taken 
in large quantities, possesses the power to lessen pain and sensa- 
tion. The anesthesia produced by this drug, however, is too tardy 
and prolonged to render it practically serviceable. 

General anesthetics abolish sensation throughout the whole 
body by destroying the sensibility of the nerve-centers — directly, 
by affecting the nervous tissue, or indirectly, by influencing the cir- 
culation, or the blood, in such a manner as to interfere with the 
functional activity of the nerve-cells. 



ANESTHETICS. 421 

The detailed action and uses of anesthetics are fully described 
under " ^Ether " and " Chloroformum." 

Local anesthetics are used to deaden the sensation or abolish 
the sensibility of the peripheral nerves of a localized, particular 
area. The most important are — cocaine, carbolic acid, iodoform 
eugenol-acetamide, and antipyrine. Some aromatics are also quite 
powerful anesthetics. The physiological action of local anesthetics 
is given under the respective agents. 

^Ether— Athens— Ether. V. S. P. 

Origin. — A liquid composed of about 96 per cent, by weight 
of Ether or Ethyl Oxide, and about 4 per cent, of Alcohol con- 
taining a little Water. 

Ether is known as sulphuric ether, and was called Aither For- 
iior by the Pharmacopoeia of 1880. 

Description and Properties. — A transparent, colorless, mobile 
liquid, having a characteristic odor and a burning, sweetish taste. 
Specific gravity, 0.725-0.728. Soluble in about ten times its vol- 
ume of water, with slight contraction of bulk. Miscible, in all pro- 
portions, with alcohol, chloroform, benzin, benzol, and fixed and 
volatile oils. 

Ether is highly volatile and inflammable, its vapor, when mixed 
with air and ignited, exploding violently. It should be kept in 
well-stoppered containers, preferably in tin cans, in a cool place, 
remote from lights or fire. 

Dose. — 15-40 minims (1.0-4.0 Cc). 

Official Preparations. 

Spiritus Athens — Spiritus Athens — Spirit of Ether. — Dose, \-\ fluidrachm 
(1.0-4.0 Cc). 

Spiritus /Etheris Comp6situs — Spiritus Athens Comp&siti — Compound 
Spirit of Ether (Hoffmann's Anodyne). — Ether, 325; Alcohol, 650; Ethereal Oil, 
25 parts. Dose, 5-60 minims (0.3-4.0 Cc.). 

Antagonists and Incompatibles. — The stimulant and anodyne 
action of ether is antagonized by the arterial sedatives, the tetaniz- 
ing alkaloids, strychnine, picrotoxin, etc. 

Synergists. — The arterial and cerebral stimulants, chloroform 
and other anesthetics, and alcohol. 

Physiological Action. — Externally and Locally. — Ether when 
applied to the skin produces intense cold by its rapid evaporation. 
If it is confined and its evaporation prevented, great irritation is 



422 A TEXT-BOOK OF MATERIA MEDICA. 

excited. By spraying a part with ether it becomes quickly frozen, 
marked local anesthesia being produced thereby. 

Applied to mucous membranes, it creates considerable irritation, 
especially of the fauces and respiratory tract when inhaled. 

Internally. — Digestive System. — It is a carminative, increasing 
peristalsis and the secretions from the pancreas and the salivary 
and gastric glands, at the same time dilating the vessels of the 
stomach. 

Circulatory System. — When taken into the stomach ether re- 
flexly stimulates the heart in a manner similar to that of alcohol, 
raising arterial tension by increasing the force and frequency of the 
heart's action. 

Ether stimulates the heart and increases the blood-pressure when 
inhaled. It is a diffusible, rapid, and reliable cardiac stimulant. In 
very large or poisonous amounts it exhausts the heart by over- 
stimulation, acting as a cardiac depressant. 

Nervous System. — Ether first occasions a considerable degree 
of excitement, due to the direct action of the ethyl upon the cere- 
bral cortex. Its action in this respect is analogous to that of 
alcohol, and, like the latter drug, it affects the nervous system in a 
certain order, primarily stimulating and afterward depressing, first, 
the cerebral hemispheres ; second, the sensory areas of the spinal 
cord ; third, the motor areas of the spinal cord ; fourth, the sensory 
centers of the medulla oblongata ; and, finally, the motor areas of 
the medulla. The motor nerves and muscles are unaffected. 

Respiratory System. — Medicinal doses stimulate and poisonous 
doses paralyze the respiratory center. 

Respiration is frequently arrested at the beginning of ether- 
inhalation, owing to reflex spasm arising from irritation of the 
peripheral ends of the vagi and trigeminy As the inhalation is 
continued the breathing becomes deeper and faster from stimula- 
tion of the respiratory center. This part of the nervous system 
may, in fact, become exhausted from over-stimulation, when the 
respirations are slow and shallow. 

In fatal cases of ether-narcosis the respiration is usually arrested 
before the cessation of the heart's action. 

Absorption and Elimination. — Ether is rapidly eliminated, chiefly 
by the lungs, but also by the kidneys, which are often considerably 
irritated by the process. 

Temperature. — The prolonged administration of ether produces 
a great reduction of temperature — doubtless due to the depression 



ANESTHETICS. 423 

of the circulation and respiration and the rapid evaporation of the 
drug chilling the body and lungs, rather than to any direct action 
upon the nervous mechanism presiding over the heat-centers. 

In brief, the action of ether when inhaled is as follows : At first 
a sensation of choking and irritability of the respiratory mucous 
membrane is experienced. A greatly increased activity of the sali- 
vary glands follows, accompanied by a sensation of pricking or 
tingling of the hands and feet. The conjunctiva is injected, the 
face is flushed, the veins of the neck are distended, and there is 
experienced a peculiar feeling of lightness, together with a perver- 
sion of all the senses, due to emotional excitement. The patient 
may yell, laugh, cry, curse or pray, struggle or become pugilistic, 
while the breathing may be spasmodic or stertorous, the pulse 
becoming rapid and strong. 

As the inhalation is continued the respiration is quickened, the 
skin becomes moist and warm, and relaxation of the muscles en- 
sues, with abolition of reflexes, contracted pupils, and complete 
suspension of sensation. Finally, as perfect unconsciousness super- 
venes, the pupils are dilated ; the respiration is slow and deep, and 
later very weak ; and the skin is cool and moist. 

If the inhalation be discontinued before a toxic quantity of ether 
has been administered, consciousness gradually returns — in some 
cases almost at once, although some loss of sensation and muscular 
weakness remain for a while. 

The return of consciousness is usually accompanied by retching 
and vomiting — often by severe rigors, unless care has been taken 
to keep the patient warm. Great excitement not infrequently 
attends this stage of etherization. 

Treatment of Untoward Manifestations. — Withdraw the ether if 
there be danger of respiratory or cardiac failure, lowering the head 
if there be indications of the latter, and if respiratory failure be 
threatened, as indicated by cyanosis, avoiding a prostrate position. 
Meanwhile, other measures for the relief of cardiac or respiratory 
failure may be resorted to : artificial respiration, friction, or the 
electric current to excite respiratory action, one electrode being 
placed upon the larynx and the other upon the epigastrium. Hy- 
podermic injections may be resorted to — of strychnine, digitalis, or 
atropine, or, in desperate cases, of ammonia. 

When asphyxia is produced by the lodgement of mucus in the 
respiratory passages, the hypodermic injection of ether itself is per- 
missible, if necessary, to excite more vigorous respirations. 



424 



A TEXT-BOOK OF MATERIA MEDICA. 



Should nausea become too persistent, a hypodermic injection of 
morphine will usually suffice to quiet it. 

Ice-water or a little ether poured over the epigastrium will 
establish regular respirations when suspended, as is often the case, 
during the first stage of anesthesia. 

Therapeutics. — Externally and Locally.. — The hypodermic in- 
jection of 15 minims (1.0 Gm.) of ether in close proximity to the 
affected nerve has been found valuable in neuralgia and sciatica. 

The hypodermic method of administration has been also prac- 
tised in the treatment of shock and in the threatened collapse fol- 
lowing post-partum hemorrhage, as well as for the cure of sebaceous 
cysts. 

The local anesthetic properties of ether render it valuable in 
many diseases of the skin, such as pruritus, urticaria, etc. For 
treatment of these disorders it is usually combined with some 
aromatic. 

A wet compress saturated with ether has been successfully 
applied to the forehead for the relief of epistaxis. 

Internally. — Ether is used as an antispasmodic in order to facili- 
tate certain examinations, the reduction of dislocations, and to 
relieve pain in the general practice of surgery, obstetrics, and den- 
tistry. 

It has been used as an anthelmintic against tape-worms. 

The compound spirit of ether is a stimulant, antispasmodic, 
and anodyne. It is an efficient remedy for gastralgia and flatulent 
colic, and is used to allay many of the symptoms of hysteria, as well 
as restlessness and insomnia unaccompanied by fever. Palpitation of 
the heart and nausea due to the excessive use of tobacco are also 
greatly benefited by this preparation. In angina pectoris and hic- 
cough it is an efficient remedy. 

Contraindications. — Acute or chronic disease of the kidneys. 
Dilatation or fatty degeneration of the heart. Disease of the 
lungs. Tumors of the brain or about the neck, Atheromatous 
condition of the arteries. Enlarged tonsils, chronic alcoholism, 
or aneurysm. 

It is necessary at times to give an anesthetic in the foregoing 
cases, and the surgeon is justified in the use of ether, but the 
administration should be extremely careful and conducted under 
skilful supervision whenever the above contraindications exist — 
particularly in conditions of dilated or fatty heart or chronic 
alcoholism. 



ANESTHETICS. 



425 



Administration. — In administering anesthetics the following 
precautions should be taken : 

The stomach of the patient should contain no food. 

The clothing should be loose about the neck, thorax, and ab- 
domen, allowing perfect freedom of respiration. 

Artificial teeth should be removed. 

It should be remembered that ether is inflammable, and, when 
its vapor is mixed with air, explosive : it should, therefore, not be 
used near a flame or an actual cautery, from which it may ignite. 

The patient should be kept covered, in order that there may not 
be too great a reduction in temperature. He should, moreover, be 
watched for several hours after the administration, since there is 
always more or less danger until the effects of the ether have 
entirely disappeared. 

Under proper methods the administration of ether occasions 
little inconvenience. In addition to the recommendations above 
given, it may be added that smearing the mouth and nose with 
oil prevents the excoriation frequently occasioned by contact with 
the anesthetic. 

There are various means of administration, the simplest and in 
many cases the most efficient being a towel shaped into a funnel or 
hollow cone, with a piece of stiff paper laid between the outer folds 
to preserve the shape. Among many mechanical contrivances the 
inhaler of Dr. O. H. Allis of Philadelphia is perhaps the best. At 
the Massachusetts General Hospital a cone-shaped sponge is 
employed. 

In using the towel-cone the inner surface is saturated with 
about half an ounce of ether, the inhaler at first not being placed 
close to the mouth and nose, thus allowing the vapor to be suf- 
ficiently diluted with air. The effect of this method is to accustom 
the air-passages to the primary irritation of the anesthetic and 
graduate its effects. After this the towel may be pressed close to 
the mouth and nose and the concentrated ether freely adminis- 
tered. In this manner a person may become completely etherized 
without nausea or resistance. The insensibility of the conjunctiva 
and complete relaxation of the muscles, accompanied by semi- 
stertorous breathing, indicate that the stage of desirable anesthesia 
is attained. The quantity of ether administered should now be 
reduced, further supplies being limited to the amount requisite to 
maintain complete anesthesia. 

The symptoms incident to the primary effects of etherization — 



426 A TEXT-BOOK OF MA TERIA MEDICA. 

cerebral excitement, muscular activity, etc. — should not induce 
withdrawal of the anesthetic, but rather its continuance. Should 
vomiting occur at this stage, etherization should be suspended 
and the mouth thoroughly cleansed by means of a sponge or a 
towel. 

Complete loss of consciousness marks the following stage of 
anesthesia, when total relaxation supervenes, accompanied by 
gentle, regular breathing. Should stertorous respiration attend 
further etherization, it is a warning of paresis, and the drug should 
be withdrawn. 

Congestion of the facial muscles during anesthesia is quite 
normal, pallor, as a rule, indicating cardiac or respiratory debility. 
The practice of closely covering the face is thus to be discouraged, 
since it conceals important symptoms of the patient's physiological 
condition. The danger from asphyxia in complete etherization is 
shown by the entire muscular relaxation of the tongue, which is 
prone to drop backward, and the closing of the glottis, suspending 
respiration. In such an occurrence the jaw should be pressed for- 
ward, the head being well extended, and, if necessary, the tongue 
brought forward with the forceps. 

The pulse, respiration, color, and pupillary reflex are the main 
points under observation by the anesthetist. At first the rapidity 
of the pulse is usually increased by reason of excitement ; later it 
becomes slower and fuller, and when it becomes very slow and 
feeble, it is wise to ease the patient. The respirations, after the 
preliminary choking and gagging, become full, deep, and slower. 
As anesthesia progresses they become shallower and shallower, 
and should always be watched with a critical eye, especially if 
cyanosis develops. This indicates the danger-limit to which etheri- 
zation may proceed. The eyes exhibit a variety of changes and 
differ in every individual. The usual rule is to have a preliminary 
dilatation, and during narcosis a moderate state of contraction. If 
marked dilatation occurs in deep narcosis, this is an indication of 
poisoning and for the withdrawal of the anesthetic. 

Under favorable conditions from five to twelve minutes are re- 
quired to etherize the patient completely. The effects of anesthesia 
upon recovery vary with the temperament and character of the 
individual and the conditions under which the drug is administered. 
Great excitability may attend awakening from etherization, or the 
patient may return to consciousness as from a tranquil slumber. 
Nausea and vomiting frequently accompany rallying from the 



ANESTHETICS. 



427 



narcosis — not, however, such as may require especial treatment. 
Should somnolence be manifested, it is best not to rouse the 
patient, that the awakening may be easy and natural. 

In etherizing a female patient the presence of a woman is always 
desirable, in order that her testimony may assuage certain abnor- 
mal impressions to which women during anesthesia are prone, the 
hallucinations being more readily dispelled by one of their own 
sex. To the operator and attendants her presence is also of 
importance. 

Great care should be taken to see that the patient is well cov- 
ered and not exposed to drafts, in its relaxed condition the body 
being peculiarly susceptible to pneumonia or pleurisy. The anes- 
thetic should be carefully examined before administration, and the 
character of the drug thoroughly known. 

Chloroformum— Chloroformi— Chloroform. U. S. P. 

Origin. — A liquid consisting of from 99 to 99.4 per cent., by 
weight, of Absolute Chloroform, and from 1 to 0.6 per cent, of 
Alcohol. 

Description and Properties. — A heavy, clear, colorless, mobile, 
and diffusible liquid, of a characteristic ethereal odor and a burning 
taste. Specific gravity, not below 1.490. Soluble in about 200 times 
its volume of cold water, and in all proportions in alcohol, ether, 
benzol, benzin, and fixed and volatile oils. 

Chloroform is volatile, even at a low temperature, and boils at 
6o° to 6i° C. (i40°-i4i.8° F.). It is not inflammable, but its 
heated vapor burns, emitting a green flame. It should be kept in 
dark, amber-colored, glass-stoppered bottles, in a cool and dark 
place. 

(See tests for chloroform in U. S. Pharmacopoeia, p. 88.) 

Dose. — 2-15 minims (0.1 2-1.0 Cc). 



Official Preparations. 

Aqua Chlorof6rmi— Aquae Chlorof8rmi— Chloroform Water.— Dose, 1-4 
fluidrachms (4.0-16.0 Cc). 

Emulsum Chlorofdrmi— Emulsi Chloroffirmi— Chloroform Emulsion.— 
Dose, 1-4 fluidrachms (4.0-16.0 Cc). 

LinimSntum Chlorofdrmi — Linimenti Chloroftirmi — Chloroform Liniment. 
— For external use. Chloroform, 30; Soap Liniment, 70 parts. 

Spfritus ChlorofSrmi— Spiritus Chlorofdrmi— Spirit of Chloroform.— Dose, 
10 minims-i fluidrachm (c. 6-4.0 Cc). 



428 A TEXT-BOOK OF MATERIA MEDICA. 

Unofficial Preparations. 

Chlorodyne. — This preparation was first introduced by Dr. Collis Browne of Lon- 
don. Numerous formulse for chlorodyne have been published, the British Pharmacopoeia 
containing an official preparation, Tinctura Chloroformi et Morphince, intended as a 
substitute for chlorodyne, and composed of chloroform, ether, alcohol, morphine 
hydrochlorate, dilute hydrocyanic acid, oil of peppermint, fluid extract of liquorice, 
treacle, and syrup. Dose, io minims (0.6 Cc.). Parke, Davis & Co. of Detroit, 
Mich., prepare a similar and excellent compound known as Chlor- Anodyne. 

The different preparations of chlorodyne and its substitutes vary greatly in the dose, 
from 5 minims to I fluidrachm (0.3-4.0 Cc.) ; in prescribing, therefore, the strength of 
the agent should be ascertained. Remedies of this character possess powerful narcotic, 
anodyne, and antispasmodic properties, and should be administered cautiously and only 
under the direction of a physician. 

In addition to the above, there is an efficient carminative and antispasmodic known 
as Tinctura Chloroformi Composita (B. P.) — dose, 20 minims-i fluidrachm (i. 2-4.0 
Cc.) — containing chloroform and compound tincture of cardamom and various anesthetic 
mixtures; and chloroform ointments of different strengths. 

Antagonists and Incompatibles. — Chloroform will not mix 
with weak spirits or glycerin. Circulatory and respiratory stimu- 
lants and galvanism antagonize to some extent its poisonous action. 
There is no chemical antidote. 

Synergists. — Anesthetics, alcohol, morphine, chloral, and many 
of the hypnotics. 

Physiological Action. — Externally and Locally. — Its action is 
similar to that of ether, though when confined on the skin it pro- 
duces vesication. It is more. of an irritant to mucous membranes than 
ether, yet when inhaled it is less irritating to the respiratory tract. 

Internally. — Digestive System. — Its action upon the digestive 
tract is nearly identical with that of ether, except that when taken 
in a concentrated form it occasions marked irritation of the stom- 
ach and intestines, often resulting in violent gastro-enteritis. 

Circulatory System. — Chloroform depresses the heart and cir- 
culation, the former by weakening the cardiac muscle, and the 
latter by lowering arterial pressure by depressing the vaso-motor 
center. It frequently produces an intermittent pulse by stimulating 
the inhibitory ganglia of the heart. 

Nervous System. — It affects the brain and spinal cord in the 
same manner and order as ether, like it producing death, usually 
by respiratory failure, though sometimes the heart first succumbs 
to the influence of the drug. 

When locally applied the sensory and motor nerves are affected 
in the same manner as by ether. Small amounts of chloroform 
stimulate, and large quantities depress, the nervous system. 



ANES THE TICS. 429 

Respiratory System. — Its action closely resembles that of ether, 
though its operation is more rapid and powerful. 

Absorption and Elimination. — Chloroform affects the kidneys by 
irritation, certain investigators claiming that acute nephritis ensues, 
blood and albumin being often present; it is certainly less irritating 
than ether. 

Temperature. — It depresses the temperature, although probably 
by a different action from that of ether, reducing bodily tempera- 
ture by lessening heat-production and increasing heat-dissipation. 

Untoward Action. — If there be any marked idiosyncrasy against 
chloroform, death usually occurs suddenly after a few inhalations 
of the drug. 

When applied externally there is produced not infrequently an 
urticaria- like eruption or an eczematous condition of the skin ; 
vesicles may result. If applied to sensitive portions of the skin, 
such as the scrotum, severe and persistent pain is sometimes occa- 
sioned. Frequently, when applied to wounds and mucous mem- 
branes, it causes intense irritation, so much so that the mucous 
membrane may be shed in pieces. 

The symptomatic manifestations of chloroform-anesthesia, the 
methods of administration, and the treatment of chloroform acci- 
dents are here given in detail. 

The phenomena attending the administration of chloroform in- 
dicate three separate stages of narcosis. The first of these is allied 
to intoxication induced by alcoholic stimulants. In this stage, 
although sensation is dulled, consciousness is retained, and, al- 
though the period is brief as a rule, in some patients, such as those 
of intemperate habits, it may last for some time and be accom- 
panied by violent excitement. In such cases the administration 
of chloroform is attended with no little danger. 

The second stage, available for surgical operations, is one of 
complete anesthesia. The patient is perfectly passive, conscious- 
ness and sensation being for the time wholly obliterated. 

The third stage is the most delicate to deal with, profound un- 
consciousness, with stertorous breathing and total muscular relaxa- 
tion, as well as temporary annihilation of reflexes, indicating the 
danger-line of anesthesia. Only under extreme necessity should 
the administration be carried thus far. 

It is well to guard against taking the pulse as an infallible guide 
to the patient's condition. In each successive stage the cardiac 
movements are variable, although, generally speaking, certain 
pulsations accompany the above-named degrees of narcosis. 



430 A TEXT-BOOK OF MATERIA MEDIC A. 

As has been suggested in the case of ether, a few precautions in 
the administration of chloroform are obvious — that there be no 
undigested food in the stomach ; that the clothing be loose about 
the neck, chest, and abdomen ; and that artificial teeth be removed. 

The appliances used in producing anesthesia by the aid of 
chloroform are various, the simplest, as in the administration of 
ether, being a cone formed of a napkin or a towel enclosing a sponge 
or not, a sponge alone, or a handkerchief, upon which a small 
quantity of chloroform — not exceeding from a half to one fluid- 
drachm (2.0-4.0 Cc.) at a time — is poured. The utmost vigilance is 
requisite in the administration, the respiration, pulse, and facial 
indications being constantly observed; a supply of air being 
allowed to mingle with the anesthetic to obviate the dangerous 
effect of its concentrated vapor; and the drug being instantly 
withdrawn upon the slightest indication of untoward symptoms, 
such as lividity of the face, debility of heart-pulsations, and ster- 
torous or spasmodic respiration, and an ominous dilatation of the 
pupils. 

Should respiration cease, the tongue should immediately be 
brought forward or the lower maxillary manipulated as in the case 
of ether. Should these resources be unavailing, artificial respira- 
tion or the galvanic current should be tried. To restore cardiac 
action nitrite of amyl may be used, or hypodermic injections of 
ammonia or digitalis as a cardiac stimulant. 

A mixture of ether and chloroform has been suggested by com- 
petent authorities as the safest and most efficient anesthetic. Yet 
its utility in many cases has proved doubtful, experience in opera- 
tive surgery rather inclining to the use of a single agent. 

Although the symptomatic features of chloroform-narcosis, 
especially those which accompany collapse and death, have been 
studiously examined, the conditions causing disaster are still but 
imperfectly understood. Nevertheless, premonitory indications are 
seldom wanting which mark clearly enough the limit of safety in 
administration. Of these, extreme mydriasis and failure to pro- 
duce reflex action in the conjunctiva are alone symptoms to be 
regarded with the gravest apprehension. 

The statistics of deaths from chloroform present a melancholy 
yet instructive spectacle to the thoughtful physician, and the deduc- 
tions drawn from them go far to show the value of exceeding cau- 
tion in the use of so subtle and powerful an anesthetic. The 
pathological considerations of any given case fail to throw light 



ANESTHETICS. 431 

upon the immediate cause of the patient's collapse, the cessation 
of respiration or stoppage of the pulse resulting in syncope or 
asphyxia varying in their mutual order and coincidences. 

It is not to be inferred that chloroform is of itself necessarily 
dangerous, its noxious effects depending upon its administration 
rather than upon the drug. An instance of its harmless use is 
found in the method of producing partial and temporary anesthesia 
adopted by some physicians in cases of childbirth, neuralgia, etc., 
by which the patient is permitted to administer the anesthetic. 
This method consists in saturating with chloroform a small sponge 
placed in a cup or tumbler, and allowing the patient to inhale the 
fumes at will. Before the system can absorb a lethal quantity of 
the drug muscular relaxation intervenes and the hand involuntarily 
drops, the semi-conscious state meanwhile dulling sensation and 
causing the patient to forget pain. Upon the return of conscious- 
ness the administration may be repeated, with little danger of un- 
toward results from the small amount of chloroform inhaled. The 
bottle, it is hardly necessary to say, should never be entrusted to 
the patient. 

Additional Anesthetics, and their Comparative Value. 

Ethyl Bromide. — A colorless, inflammable liquid, with a burn- 
ing taste and an odor like that of chloroform. It is readily decom- 
posed, with evolution of bromine. Its action is uncertain, causing 
great irritation of the respiratory passages, and usually producing 
death by paralysis of respiration. 

Ethyl Chloride. — A volatile, colorless, and inflammable liquid 
having a pleasant odor. It is a very fugacious anesthetic, greatly 
depressing the heart and respiration, and is mainly used, in the 
form of a spray, to produce local anesthesia. 

Ethyl Iodide. — A liquid anesthetic, similar in its physiological 
action to chloroform. Anesthesia produced by it, however, is more 
tardy, although more permanent. It is considered a comparatively 
safe and efficient anesthetic to relieve spasm of the respiratory 
passages, as in asthma and laryngitis. 

Ethylene Bichloride. — More rapid and powerful in its action 
than chloroform, though not so safe, affecting the respiratory center 
invariably before influencing the heart. While speedier in its action 
than ether, it is probably more dangerous. 

Ethylene Bromide. — A weak yet dangerous anesthetic, "greatly 
depressing the respiratory center, and tending to cause paralysis 
of the extremities and stoppage of the heart. 



432 A TEXT-BOOK OF MA TERIA MEDICA. 

Ethylidene Chloride. — A non-inflammable liquid resembling 
chloroform in its physical appearance, and in its physiological 
action as well, although much less depressant to the heart. It 
causes more irritation to the respiratory passages, with vomiting 
and great languor and discomfort as its sequelae. 

Ethylene Iodide. — A crystalline substance, its fumes when 
heated producing anesthesia, with great irritation of the respiratory 
passages, and death by asphyxia. 

Methyl Chloride. — A colorless, inflammable gas, with a taste 
and odor resembling those of ether and chloroform. Cold lique- 
fies it. It is used locally to produce anesthesia and to relieve pain 
in neuralgia. 

Methylene Bichloride. — A colorless liquid, its odor being like 
that of chloroform. Exposure to the light decomposes it. Anes- 
thesia produced by this agent is accompanied with comparatively 
little irritation of the respiratory tract, but it occasions a primary 
stage of excitement like that induced by ether, and, as in the case 
of chloroform administration, vomiting is likely to ensue. Death 
takes place from paralysis of the heart. The numerous fatalities 
which have occurred under this anesthetic indicate the danger of 
its use, and its volatility renders its employment difficult in a hot 
atmosphere. 

Carbon Tetrachloride — Tetrachlormethane. — A transparent, 
colorless liquid, of an agreeable aromatic flavor, analogous in its 
action to chloroform, but less irritating, although far more danger- 
ous to the heart. 

Formic Ether. — A thin, colorless, inflammable liquid, of strong, 
agreeable odor and pungent taste. It acts like chloroform, though 
the signs of asphyxia are less marked. Its effects last for several 
hours. 

Methylic Ether. — A colorless, inflammable gas, heavier than 
air, of an ethereal odor and aromatic taste. Richardson considers 
it a safe anesthetic, though objectionable because of its odor — less 
agreeable than those of ether and chloroform — and the rapidity 
with which it volatilizes from its solution. 

Methylal — Methylen — Dimethyl Ether. — A highly volatile, 
colorless, limpid liquid, of penetrating ethereal odor. It is used 
chiefly as a local anesthetic and as an efficient hypnotic in insanity 
and delirium tremens. 

Acetic Ether (U. S. P.). — A colorless, limpid, volatile liquid 
having an agreeable, refreshing, ethereal, and somewhat acetous 



ANESTHETICS. 433 

odor and taste. It has the advantage over sulphuric ether of being 
less inflammable and less volatile. Owing to its pungent and 
agreeable odor, too, it is superior to the latter drug in stimulating 
the nasal passages in cases of syncope and nervous agitation. 

Pental. — A colorless, volatile, inflammable liquid, insoluble in 
water, but miscible in all proportions with alcohol, ether, and chlo- 
roform. It has a mustard-like odor, and is comparatively free from 
danger. When poisonous amounts are administered the pulse is 
quickened, the respiration embarrassed, and death ensues from 
paralysis of the heart. It resembles chloroform rather than ether, 
but is less irritating and seldom accompanied by unpleasant after- 
effects. It requires but about 5 drachms (20.0 Cc.) to produce 
anesthesia, which occurs in from two to three minutes. 

There is a difference of opinion as to the safety of pental, some 
physicians considering it less dangerous than chloroform, and others 
regarding it as less efficient and not so safe. 

Nitrous Oxide ("Laughing" Gas"). — A colorless gas, of a very 
slight, agreeable odor and sweetish taste. It is not inflammable, 
but supports combustion of ignited bodies. Pressure and cold 
condense it into either a thin, colorless, very mobile liquid or 
colorless crystals. It is a rapid anesthetic, unconsciousness being 
produced in from one-half a minute to three minutes. The pulse is 
strong and quick, the respirations frequent and shallow, while, as 
the inhalation continues, the breathing becomes stertorous and the 
face is cyanotic. If the inhalation be interrupted or the gas mixed 
with air, symptoms of intoxication are manifested, accompanied by 
a high degree of mental excitement. It is a very safe anesthetic, 
but the anesthesia is of quite short duration, rendering it valuable 
mainly for the extraction of teeth and in minor surgery. 

The comparative value of ether and chloroform may be sum- 
marized as follows : 

1. If an anesthetic be required, ether is preferable in the case 
of a patient suffering from a weak cardiac action or an organic 
disease of the heart. 

2. For operations about the face or of the stomach, as there is 
less danger of reflex inhibition of the heart, ether is preferable to 
chloroform. 

3. Ether is preferable as an anesthetic in the extraction of teeth, 
chloroform being more apt to cause cardiac paralysis, reflexly by 
way of the dental nerve to the root of the vagus, and through the 
vagus to the inhibitory ganglia of the heart-muscle. 



434 A TEXT-BOOK OF MA TERIA MEDICA. 

4. Ordinarily, ether is superior to, and safer than, chloroform as 
an anesthetic for adults, unless some special contraindication exist, 
there being less danger in ether of cardiac failure, to which adults 
are more liable. 

Chloroform is much superior to ether in — 

1. Obstetrics, since the use of it is attended with less depression 
and irritation of the respiration and respiratory tract. Moreover, 
chloroform produces less nausea and vomiting, and may be admin- 
istered by the patient herself under proper directions. 

2. It is preferable in anesthetizing children, being more rapid in 
its action and less potent as a respiratory depressant, the respiratory 
center of the child being more susceptible than that of the adult, 
and in children the danger of cardiac paralysis being slight. 

3. Should the patient be suffering from nephritis, chloroform is 
preferable as an anesthetic, since it is less irritating to the kidneys. 

4. Should an anesthetic be required for patients afflicted with 
pulmonary tuberculosis, empyema, or other disease of the lungs, 
chloroform should be used, since its effect upon the respiratory 
system is less depressing. 

5. It is preferable in very hot climates, as ether boils at 37 C. 
(98.6 R). 



GROUP IV.— HYPNOTICS. 

Chloral-Chloralis— Chloral. U. S. P. 

Origin. — A crystalline solid composed of Trichloraldehyde or 
Chloral (an unstable, oily, and colorless fluid), with 1 molecule of 
Water, forming the Hydrate of Chloral, the official preparation, 
and the only one used in medicine. Chloral itself is prepared by 
the action of Chlorine upon Alcohol, whence the name chlor-al. 

Description and Properties. — Chloral hydrate occurs as sepa- 
rate, rhomboidal, colorless, transparent crystals, having an aromatic, 
penetrating, and slightly acrid odor, and a bitterish, caustic taste. 
It is slightly volatilized when exposed to the air, and is freely solu- 
ble in water, alcohol, and ether, being also soluble in chloroform, 
benzol, benzin, carbon disulphide, and fixed and volatile oils. It 
liquefies when triturated with an equal quantity of camphor, 
menthol, thymol, or carbolic acid. 

Dose. — 5-20 grains (0.3-1.2 Gm.). 



HYPNOTICS. 435 

Unofficial Preparations. 

The proprietary preparation known as Brorrrtdia contains to each drachm (4.0 Cc.) 
15 grains (1.0 Gm.), each, of Chloral and Potassium Bromide, together with a small 
quantity of Extract of Hyoscyamus and Extract of Cannabis Indica. 

Camphorated Chloral. — Equal parts of Chloral and Camphor. A colorless liquid, 
of syrupy consistence, soluble in alcohol, ether, chloroform, glycerin, and fixed oils, and 
also in aqueous solutions of chloral. It is decomposed by water, chloral hydrate being 
dissolved and camphor precipitated. 

Chloral-glycerite is prepared by dissolving 1 drachm (4.0 Gm.) of Chloral in 4 
drachms (15.0 Cc.) of Glycerin, being used as a solvent for powerful alkaloids. 

Chloral -ph€nol. — Prepared by tnturating equal parts of Chloral and Carbolic Acid. 
It occurs as a colorless, viscid liquid, with a sweet caustic taste. Used externally. 

Allied Compounds. 

Amylene Hydrate. — A tertiary alcohol, the chemical name being dimethylethyl- 
carbinol. 

Description and Properties. — It occurs as a limpid, colorless, neutral fluid, of a 
peculiar odor and burning taste. It is soluble in 8 parts of water, and miscible in all 
proportions with alcohol, chloroform, benzin, glycerin, and fixed oils. 

Dose. — 1-2 fluidrachms (4.0-8.0 Cc). 

Chloral-ammonium. — Obtained by passing a rapid current of dry Ammonia 
through a solution of Anhydrous Chloral and Chloroform as long as it is absorbed. Its 
chemical name is trichloramidethylic alcohol. It occurs as small, white acicular crys- 
tals, and is soluble in alcohol and slightly soluble in water, although the aqueous solution 
is unstable. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

Chloralose. — Prepared by heating equal quantities of Anhydrous Chloral and dry 
Glucose ; hence the name, chloral-ose. 

Description and Properties. — It occurs in the form of fine needles, completely vola- 
tilizing without decomposition. It has an acrid, nauseous taste, and is soluble in hot 
water and in alcohol. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Hypnal. — A compound of Chloral and Antipyrine, known as monochlorantipyrine. 
A similar preparation containing more chloral is called dichloralantipyrine. 

Description and Properties. — It occurs in the form of transparent, rhombic crystals, 
odorless and tasteless, soluble in from 5 to 6 parts of water. 

Dose. — 5-20 grains (0.35-1.3 Gm.). 

Hypnone. — A term given by Dujardin-Beaumetz to a member of the ketones, 
known as acetophenone or phenylmethyl-ketone, phenomethy I- acetone. 

Description and Properties. — A colorless, mobile, refrangent liquid, of a pungent 
taste and a persistent odor resembling that of bitter almond and orange. It is not 
inflammable, though intensifying the combustion of substances impregnated with it. It 
is freely soluble in alcohol, ether, chloroform, benzin, and fixed oils, sparingly soluble 
in glycerin, and insoluble in water. 

Dose. — 5-10 minims (0.3-0.6 Cc). 

Unofficial Preparations.— A Syrup and an Elixir of Hypnone are in use. 

Ural— Chloral-Grethane— Uralium.— A compound of the following drug, Ure- 
thane, and Chloral Hydrate. 

Description and Properties. — A crystalline body, soluble in alcohol and ether, in- 
soluble in cold water, and decomposed by boiling water. 



436 A TEXT-BOOK OF MATERIA MEDICA. 

Dose. — 10-30 grains (0.6-2.0 Gra.). 

Orethane — Ethyl Carbamate — Ethyl Orethane. — This substance is obtained 
by the action of Ammonia on Ethyl Carbonate, or by that of Urea or Carbamide on 
Ethyl Alcohol at a high temperature. 

Description and Properties. — It occurs as colorless, odorless, columnar or tabular 
crystals, having a pleasant, cooling, and saline taste, somewhat resembling that of salt- 
petre. It is soluble in about 1 part of water, and in like proportion in ether and chlo- 
roform, in 0.6 part of alcohol, 0.8 part of liquefied carbolic acid, 3 parts of glycerin, 15 
parts of castor oil, and 20 parts of olive oil. 

Dose. — 10-45 grains (0.6-3.0 Gm.). 

Chloretone — acetone chloroform — is the trade name of an old chemical com- 
pound, trichlortertiary butyl alcohol. 

Description and Properties. — It is a white, crystalline substance, sparingly soluble in 
cold water, but freely soluble in hot water, ether, alcohol, and chloroform. It has a 
camphoraceous odor and a not unpleasant taste. 

Dose. — 5-10 grains (0.30-0.60 Gm.) or even double this dosage. Best administered 
in powders or in alcoholic menstruum. 

Antagonists and Incompatibles. — Chloral is incompatible with 
all alkalies, and calcic hydrate converts it into formate of calcium 
and chloroform. 

Liebreich considers strychnine an antagonist to chloral. But 
from the fact that the principal action of strychnine is upon the 
reflex centers in the spinal cord, its efficacy in opposing chloral 
is certainly inferior to that of chloral as an opponent to strych- 
nine. Atropine is undoubtedly a stronger antagonist in counter- 
acting the depressing influence of chloral upon the heart and 
respiration, as well as upon the spine. External heat is also an 
opponent. 

Synergists. — All the hypnotics favor its characteristic property 
of producing sleep. Morphine enhances its hypnotic effects, while 
lessening its depressing influence upon the heart. 

Physiological Action. — Externally and Locally. — Chloral is 
antiseptic, anesthetic, and vesicant. It produces redness and some- 
times vesication when applied to the unbroken skin, and when 
strong solutions are brought in contact with the derma or with 
wounds they may even occasion sloughing, and in healthy mucous 
membranes excite much pain. When introduced into the system 
hypodermically chloral is apt to occasion gangrenous inflammation. 

Internally. — Digestive System. — Small doses are slightly seda- 
tive to the stomach, though causing a sense of burning in the 
throat and exciting more or less salivation. Large doses some- 
times produce nausea, vomiting, and purging. 

Circulatory System. — Full medicinal doses may at first accel- 
erate the pulse, which soon, however, becomes slower, weaker, and 



HYPNOTICS. 437 

softer. Under toxic doses the heart's action may be weak, rapid, 
and irregular, when death ensues, the heart being arrested in 
diastole. 

A primary effect of chloral is to lower arterial tension by its 
depressant action upon the heart through its nervous mechanism. 
It acts similarly upon the vaso- motor center and upon the struct- 
ures in the arteriole wall, dilating the blood-vessels. 

The fluidity of the blood is increased by the action of chloral, 
and under large doses the red corpuscles are crenated and there is 
a tendency to destroy the white corpuscles. 

Nervous System. — Medicinal doses sometimes occasion a pre- 
liminary stage of cerebral excitement, due probably to a combined 
temporary stimulation of the circulation and of the brain-tissue 
itself. This is soon followed — usually in from fifteen to thirty 
minutes — by a sound, dreamless slumber, induced by a direct 
depression of the cortical cells of the psychic areas and an anemic 
condition of the brain. 

The sleep thus produced is perhaps nearer that of physiological 
slumber than any caused by other agencies, lasting from seven to 
eight hours, when the patient awakes refreshed and without malaise 
or digestive disturbance. 

As upon the circulation and the brain, so upon the nerve- 
centers, there is usually a preliminary stage of excitement, with 
exaggerated reflexes. This condition is, however, of short dura- 
tion, and is succeeded by a greatly diminished reflex irritability of 
the spinal cord and total abolition of reflexes if toxic doses have 
been taken. This action upon the spinal cord is due to the depres- 
sion of its reflex centers, as well as of the sensory centers in the 
nervous system. 

Respiratory System. — In full doses chloral is a respiratory 
depressant, rendering the breathing slower and weaker, while 
under toxic doses it may cease altogether from paralysis of the 
respiratory center. Death may result from this action or from 
paralysis of the cardiac motor ganglia. 

Absorption and Elimination. — Chloral is quite rapidly absorbed, 
and is supposed to circulate in the blood in its original state. It is 
eliminated by the lungs and skin, but chiefly by the kidneys, where 
it reappears as urochloralic acid, which consists of trichlor-ethyl 
alcohol combined with glycuronic acid, although when an exces- 
sive amount of the drug has been taken it may be found in the 
urine unchanged. It usually increases the flow of urine, which 
gives a reaction for sugar with Fehling's test. 



438 A TEXT-BOOK OF MA TERIA MEDICA. 

Temperature. — Chloral is a decided antipyretic even in medicinal 
doses, while toxic doses produce a dangerous reduction of tempera- 
ture. This action is doubtless owing to a diminution of heat-pro- 
duction by limiting oxidation in the cells of the body and increasing 
heat-dissipation by cooling the blood in the dilated cutaneous 
vessels and by surface evaporation. 

Eye. — The continued use of chloral almost invariably results in 
a contracted pupil, unless psychic alterations supervene, when the 
pupillary contraction gives place to dilatation. This action of 
chloral is due to paresis of the sympathetic nerves supplying the 
iris. Berger claims that when mydriasis is present there is usually 
a congestion of the papilla, resulting from distention of the retinal 
veins ; while, according to Ulrich, intraocular tension is lessened 
in the later stages of chloralism. 

Untoward Action. — There may occur great anxiety; disturb- 
ances of respiration, such as spasmodic breathing and even as- 
phyxia, together with disturbances of vision and swelling of the 
conjunctivae. There may also be present edema of the epiglottis, 
icterus, and various cutaneous eruptions commonly designated as 
"chloral rash." 

Poisoning. — Although one of the most powerful hypnotics 
known, extraordinary doses of chloral have failed to prove fatal, 
as many as 460 grains (29.8 Gm.) having been given without per- 
ceptible discomfort. Nevertheless, 20 grains (1.29 Gm.), an ordi- 
nary dose, have been followed by toxic effects, while 30 grains 
(1.94 Gm.) have produced death. In view of so uncertain a power 
great care is requisite in the administration of this drug. In many 
ways its action is occult, nor have careful autopsies of fatal cases 
furnished insight into the precise causes of collapse, however clearly 
certain physiological effects may be defined. 

The toxicology of chloral may be classed under two general 
heads — acute and chronic poisoning. In each of these the symp- 
toms are sufficiently marked to indicate a corresponding treatment, 
although the doubtful action of chloral hydrate has caused it to 
become the subject of special study and a more careful method of 
administration than formerly. 

Acute Poisoning. — Owing to the peculiar action of chloral, the 
symptoms of poisoning from lethal doses are those characterizing 
profound coma. The pulse is feeble, thready, and irregular ; the 
temperature falls rapidly ; there is a striking diminution in the fre- 
quency of respiration, with accompanying lividity ; the skin, par- 



HYPNOTICS. 439 

ticularly that of the forehead and extremities, is covered with cold 
sweat ; the pupil contracts and then dilates perceptibly, and great 
muscular relaxation occurs, together with abolition of reflexes, 
until finally the cerebral functions are suspended and death ensues, 
caused by paralysis of the respiratory center, the arrest of the 
heart's action taking place in diastole. Autopsies have revealed 
cerebral and pulmonary congestion, together with enlargement of 
the right cardiac cavities. Since chloral but slightly affects the 
motor nerves, and has little influence in impairing muscular con- 
tractility, it appears that the paralytic phenomena attending col- 
lapse are due chiefly to the direct action of the drug upon the 
nerve-centers. 

Treatment of Poisoning. — It is of primary importance to main- 
tain or restore the temperature by means of artificial heat- — warm 
blankets, hot bottles, friction, massage, or other resources at com- 
mand. (It has been found that animals are much less susceptible 
to chloral-poisoning when their temperatures are sustained by out- 
ward appliances than when exposed.) 

Somnolence is to be resisted by such resources as flagellation, 
friction, douches, beating with wet towels, by injection of strong 
hot coffee in the rectum, or any other means readily available. It 
must be borne in mind, however, that the toxic effects of chloral, 
unlike those of opium, tend to reduce cardiac activity, the patient 
often dying simply from exhaustion ; so that violent exercise, such 
as brisk walking, is to be discouraged as a restorative. 

In order to arrest respiratory failure and stimulate the circula- 
tion, hypodermic injections of strychnine or atropine or the admin- 
istration of other physiological antidotes, the inhalation of oxygen, 
and artificial respiration, may prove advantageous. Galvanism, 
internal stimulants, digitalis, and carbonate of ammonium have 
also been tried, with beneficial results. 

Chronic Poisoning. — Chloral toxemia, or chloralism, is a well- 
recognized development of simple dosage, in which the habitual 
use of the drug becomes as baneful and tyrannical in its operation 
as the opium-habit or confirmed alcoholism. Various symptoms 
mark the degrees of excess, in which the respiratory apparatus, 
the skin, and the entire circulation are severally affected. 

Respiration is embarrassed by the presence of dyspnea, which, 
however slight, is manifested after meals or is stimulated by physi- 
cal exertion. The skin may be subject to erythematous eruption, 
either persistent or temporarily excited by trivial causes. Finally, 



44-0 A TEXT-BOOK OF MA TERIA MEDICA. 

the gravest complications may occur in the circulatory system, 
resulting in high fever, pyemia, and ultimate collapse. 

The line of demarkation between these stages of toxemia can- 
not be infallibly drawn, the general effects of chloralism being 
somewhat dependent upon the temperament and habits of the 
individual. The following symptoms are more or less apparent in 
all cases of chronic poisoning : 

The eyes are brilliant ; the speech is voluble, often uncontrolla- 
ble ; and the manner strangely affected by nervous excitement. As 
the craving for the drug assumes the phase of monomania through 
habitual indulgence, its votary appears to border upon pronounced 
insanity. The eyes become irritable and injected, the manner more 
restless, and the subject is sensible of vacuity in the brain and 
liable to accesses of vertigo. During the daytime a listless stupor 
allied to melancholia is observable ; the appetite is uncertain, often 
entirely wanting, and digestion difficult. These symptoms are 
accompanied by profound lassitude and debility of heart-action, 
together with marked anemia, especially of the lower extremities. 
Meanwhile, the hepatic functions are deranged, the secretion of 
bile is deficient, and an increasing weakness of the limbs simulates 
paralysis. The stools are colorless and wanting in biliary elements, 
and the urine is stained with bile and at times albuminous and sac- 
charine. 

At this stage of chloralism the necessity of the drug in order 
to overcome insomnia has grown to be imperative, sleep being in- 
duced only through the agency of the accustomed hypnotic. An 
over-dose may now at any moment produce death in the manner 
above indicated, the cumulative effects of the poison with which 
the system is saturated wholly deranging the vital functions and 
rendering elimination impossible. 

The simplest treatment in these extreme cases is primarily the 
gradual withdrawal of the toxic agent, although delirium tremens 
is recorded as a result of abstention. The diet should be carefully 
regulated with a view to restoring, if possible, the decreased vitality. 
Change of scene, abundant air and exercise, chalybeate tonics, 
calmatives, and nerve-stimulants undoubtedly contribute to re- 
establish functional activity and normal circulation, and occasional 
purgatives may assist in eliminating from the system the noxious 
elements with which it has become chronically affected. 

The following prescription has been suggested as efficacious in 
cases of established chloralism : 



HYPNOTICS. 441 

R. Chloralis, ^ij vel iv; 

Morphinae sulphatis, gr. ij ; 

• Syr. lactucarii (Aubergier), f|jij; 

Aquae, q. s. ad f ^iij. 

Sig. — Dessertspoonful in water at 10 and n p. m., if necessary. 

Therapeutics. — Externally and Locally. — An injection into the 
sac of a 10 per cent, solution of chloral has been highly recom- 
mended by Marc See in the treatment of hydrocele. One ounce of 
this solution is injected, being followed in two or three days by a 
copious effusion, which is soon absorbed. 

The antiseptic properties of chloral are utilized as a wash or 
dressing in cancer of the uterus, foul ulcers, etc. For these purposes 
the strength should be from 5 to 10 grains (0.3. to 0.6 Gm.) to 1 
ounce (30.0 Cc). Gonorrhea is readily cured in many instances 
by a 1 per cent, injection of this drug. 

Spohn recommends the continued application of a solution of 1 
drachm (4.0 Gm.) of chloral in 4 drachms (16.0 Cc), each, of 
glycerin and water in cases of furuncle. 

Bromidrosis and hyperidrosis have yielded to local applications 
of from 2 to 5 per cent, aqueous solutions of chloral. 

Sir Morrell Mackenzie successfully employed a pigment com- 
posed of 25 grains (1.6 Gm.) of this drug to 1 drachm (4.0 Cc.) of 
syrup, as a local application to the throat in diphtheria. 

Camphorated chloral is often an efficient remedy for toothache, 
and, when mixed with petrolatum or simple ointment in the pro- 
portion of 1 to 7, makes an excellent application in pruritus and 
other itching diseases where the skin is unbroken. This prepara- 
tion undiluted has been used in neuralgia, painted over the affected 
nerves. 

Cregny employs a 20 per cent, solution of chloral in anal fis- 
sure, and a I per cent, solution is used in cracked nipples. 

Chloral is frequently used to preserve urine for microscopic 
examination, though it should not be added to urine reserved for 
chemical analysis intended to detect the supposed presence of 
sugar. 

Solutions of chloral are used for embalming purposes and the 
preservation of anatomical specimens. 

Internally. — The principal use of chloral internally is to depress 
the psychic mechanism and produce sleep. It is also employed to 
depress the reflexes and motor apparatus, and thereby diminish 
convulsions, and is sometimes useful in lowering the action of the 
sensory mechanism. 



442 A TEXT-BOOK OF MATERIA MEDICA. 

As a hypnotic it is especially valuable in conditions character- 
ized by excessive cerebral activity, such as insomnia resulting from 
overwork or worry, and in the wakefulness of many acute diseases 
— typhoid, typhus, and other fevers, delirium tremens, and puerperal 
mania — it is a remedy of well-known efficacy. Its depressing 
effects should always be guarded against during the active course 
of disease, as well as in delirium tremens where great cardiac 
weakness already exists. The insomnia of convalescence would 
usually indicate its use. Indeed, where no special contraindication 
to its employment exists it is the most satisfactory hypnotic we 
possess. 

On account of its powerful depression upon the motor mechan- 
ism it is a valuable drug in treating the various convulsions and 
spasmodic disorders of childhood, such as chorea, whooping cough , 
laryngismus stridulus, and all infantile convulsions and colic. 

Even in asthma, tetanus, uremic convulsions, hiccough, and 
strychnine-poisoning chloral has proved an important remedy. 

Certain forms of epilepsy, particularly the nocturnal variety, are 
benefited by this drug, and it has been found useful in angina pec- 
toris, though it should be very cautiously administered in these 
cases if there be reason to suspect valvular disease or degeneration 
of the cardiac muscle. 

The reflex vomiting in pregnancy is sometimes relieved by either 
the internal administration of chloral or by enemas. It has also 
been used to depress the reflexes in sea-sickness. 

It has given excellent results, used in rectal enemata, in the 
treatment of puerperal eclampsia. 

Spasmodic rigidity of the os uteri is greatly reduced by a 
medicinal dose of this remedy, and, while its action on the sensory 
mechanism is feeble, it is nevertheless frequently efficient in modify- 
ing the pains of labor and in quieting the alarm and allaying the 
nervous excitement of the mother. 

There are certain other pains of moderate intensity, especially 
those of neuralgia, which are temporarily more or less relieved by 
chloral. Its anodyne effect, however, is too transient to render 
chloral very popular as an analgesic. 

A combination of morphine and chloral is a very efficient ano- 
dyne and hypnotic in sleeplessness due to pain, which is palliated 
by this combination with less digestive disturbance than if the 
former drug had been used alone, and less cardiac depression than 
if the latter had been the sole remedy, the medicines thus aiding 



HYPNOTICS. 443 

each other and serving the twofold purpose of mitigating pain and 
inducing sleep. 

The author desires to recommend here chloral hydrate as an 
antipyretic. As has been previously stated, the hypnotics possess 
many of the characteristics of antipyretics, antiseptics, and anes- 
thetics. 

Chloral possesses to a considerable degree the properties of a 
typical antipyretic. It is antiseptic, somewhat volatile, and readily 
eliminated, and thought by some observers to be changed in the 
system into chloroform and sodium formate, while, if not pushed 
too far, it is not toxic. 

We know that one of the principal actions of chloral is to re- 
duce temperature ; indeed, toxic doses may exert so marked an 
effect as to produce death by loss of heat alone. 

In sthenic fevers chloral is an admirable remedy, not only as an 
antipyretic, but in allaying nervous irritability, restlessness, and 
excessive cardiac action, and, in the opinion of the author, this 
remedy claims far more attention in these cases than it has received. 

Contraindications. — Fatty heart ; marked respiratory weakness, 
whether due to acute or chronic disease of the lungs ; atheromatous 
degeneration of the blood-vessels. Owing to the lessened alka- 
linity of the blood, the action of chloral is so unfavorable in acute 
inflammatory rheumatism as to justify classing this disease under 
the present head. 

The drug should be administered cautiously, the patient being 
uninformed as to its nature in certain nervous diseases, lest he 
acquire the chloral habit. 

Administration. — As is recommended in the case of all drugs, 
only the purest article should be prescribed. Frequently the un- 
toward symptoms of chloral are due more to the impure article 
than to any idiosyncrasy against it. The recrystallized form alone 
should be used, the first dose administered not exceeding from 1 5 
to 20 grains (i.oto 1.2 Gm.), repeated as occasion may demand. 
Ordinarily, a maximum dose should not be given oftener than once 
in forty-eight hours. 

Children bear chloral well, and, as a rule, 1 grain (0.06 Gm.) 
may be prescribed for each year of the child's age. 

Enemas of chloral may be rendered less irritating by mixing 
the drug with the yolk of an egg and milk. Chloral should always 
be well diluted when given internally, especially when combined 
with sodium or potassium bromide. Its disagreeable taste may be 



444 A TEXT-BOOK OF MATERIA MEDICA. 

partially disguised by mixing the solution with peppermint water 
and elixir or syrup of orange. 

The following differences exist between the action and thera- 
peutics of chloral and those of the various allied compounds men- 
tioned above : 

Amylene Hydrate is considered by many observers to be safer than chloral, while 
its soporific effects are produced sooner, being manifested usually in from five to thirty 
minutes, the awakening being ordinarily prompt and complete. In toxic doses it para- 
lyzes the respiratory and cardiac centers. 

Its comparison with chloral is so well stated by Laves that his remarks are here quoted 
verbatim. " It has," he says, " neither the unpleasant and persistent taste and smell of 
the latter (chloral), nor the same uncertainty of action. It seems to have about half the 
strength of chloral, and, although its hypnotic action is perhaps less certain, the sleep it 
causes is more refreshing and the mind remains clearer after its use." 

Amylene hydrate is best given in a mixture of wine and syrup of liquorice; if 
administered by the rectum, it should be suspended in mucilage. 

Chlor-amm5nium is not so depressing upon the heart and circulation, yet it does 
not offer sufficient advantages over chloral to justify its use as a substitute. 

Chloralose. — Its taste is to many persons more nauseating than that of chloral, 
while its action is practically identical, though perhaps not so depressing upon the spinal 
cord, its influence being exerted rather upon the brain. It probably also possesses more 
anodyne properties, and would therefore be superior to chloral as a hypnotic in insomnia 
with pain, sleep being produced in about half an hour. 

Chloralose is best administered in capsules followed by a drink of water, to prevent 
too great irritation of the mucous membranes of the stomach. 

Hypnal. — This substance possesses more antispasmodic properties than chloral, and 
theoretically it should be a better analgesic, it being a compound of chloral and anti- 
pyrine. Yet physicians who have had the largest experience with the drug claim its 
effects to be illusory, and that it has no special value as an anodyne. Indeed, Dujardin- 
Beaumetz, who introduced the drug, regarded it more of a soporific than anodyne. 

Hypnal causes greater gastric disturbance than chloral, and, withal, cannot be recom- 
mended as an efficient substitute for it. 

It may be dissolved in almond oil and given in capsules, or administered in a mixture 
of wine and cordial or some aromatic syrup. 

Hypnone. — As a hypnotic a much weaker substance than chloral, although it has 
found some advocates as a remedy for the insomnia of alcoholism. Toxic doses para- 
lyze the heart and respiration. It should be given in capsules. 

Ural — Chloral-urethane. — A good hypnotic, yet possessing no special advantages. 
It is not so depressing upon the circulation, but is a more feeble antipyretic than chloral. 

Urethane. — Its physiological action is almost identical with that of chloral. It is 
less depressing upon the circulation and respiration, but more so upon the peripheral ends 
of the motor nerves. Acting directly upon the cerebrum, it produces a refreshing and 
dreamless sleep, with no unpleasant after-effects. Nevertheless, it is not so reliable a 
hypnotic as chloral, and its usefulness as a therapeutic agent is still a debatable question, 
probably no hypnotic having been introduced concerning the effects of which there is 
such diversity of opinion. Until, therefore, its use shall be restricted to a place uni- 
versally assigned to it, there can be no good reason why urethane should supplant chloral 
for any purpose. 

It may be given in capsules or in some pleasant water or syrup, and may also be 
conveniently administered as an injection by the rectum. 



HYPNOTICS. 



445 



Chloretone.— This is undoubtedly a valuable hypnotic with an action very similar 
to that of chloral, but if the recent studies of Impens are to be trusted, it is iy z times 
as poisonous as chloral. Chloretone is an excellent antiseptic as well as a hypnotic and 
has been widely used as a dusting-powder for wounds. It has also been employed in 
the eye and is a marked local anesthetic. Poisonous local effects are reported how- 
ever — intense local edema, etc. 

Chloral Formamidatum— Chloralis Formamidati— 
Chloral Formamide. 

(Chloralamide.) 

Origin. — Obtained as the result of the interaction between An- 
hydrous Chloral and Formamide, consisting of Chloral Anhydride 
2 parts and Formamide I part 

Description and Properties. — Chloralamide occurs as white, 
shining, odorless crystals, having a faintly bitter taste. It is solu- 
ble in 9 parts of water and in \^ parts of alcohol. 

Dose. — 10-30 grains (0.65-2.0 Gm.). 

Antagonists and Incompatibles. — It is decomposed into chloral 
with alkalies and with water at above 140 F. 

Synergists. — The bromides of sodium and potassium. 

Physiological Action. — As might be expected, when the stim- 
ulating action of ammonia is combined with the soporific action of 
chloral, as is the case in chloralamide, we have a substance much 
less depressant upon the heart and respiration than chloral, although 
probably possessing as active hypnotic properties. Its action upon 
different systems compared with that of chloral is as follows : 

Externally and Locally. — It is not so irritating to mucous mem- 
branes as chloral. 

Internally. — Digestive System. — In its action it does not differ 
essentially from chloral. 

Circulatory System. — Its influence is very feeble, producing no 
perceptible effect upon the pulse in medicinal doses. 

Nervous System. — It probably acts as powerfully upon the cere- 
bral cortex as chloral, but in medicinal doses does not depress the 
spinal cord to the same extent, though toxic doses may abolish the 
reflexes and the conductivity of the motor nerves. It produces, 
usually in from thirty minutes to one hour after its ingestion, a sleep 
which lasts from six to ten hours, with no bad after-effects. As an 
analgesic it is superior to chloral. 

Respiratory System. — It is an active respiratory stimulant in 
medicinal doses, through its influence upon the center. Toxic 
doses, on the other hand, paralyze the respiratory center. 



446 A TEXT-BOOK OF MATERIA MEDIC A. 

Absorption and Elimination. — In the blood it is converted into 
chloral and formamide, being chiefly eliminated with the urine, 
which it tends to diminish — as well as the amount of phosphates 
excreted — though it is said that the urea is increased by small and 
lessened by large doses. 

Temperature. — In medicinal doses the temperature is uninflu- 
enced. 

Untoward Action. — Restlessness, mild delirium, rapid and feeble 
heart, great thirst, nausea, and vomiting. 

Poisoning.— -Its toxic effects are similar to those of acute chloral- 
poisoning. It does not possess the cumulative action of the latter 
drug nor any tendency to induce chloralism. 

Treatment of Poisoning. — The same as for acute chloral-pois- 
oning. 

Therapeutics. — It is not employed externally and locally. Its 
therapeutic uses are similar to those of chloral. As a hypnotic it 
is superior when there is cardiac or respiratory weakness. In the 
insomnia of neurasthenia it is especially valuable, and, in conjunction 
with potassium bromide, is preferable to a like combination with 
chloral in cases of sea-sickness. 

By many physicians it is thought to relieve pain better than 
chloral, which, if true, would render it superior in insomnia com- 
plicated with pain. 

Administration. — It is best given in aromatic elixir or some 
other dilute alcoholic vehicle. Simple syrup slightly acidulated 
with hydrochloric acid, beer, and sweet wine are also recommended 
as pleasant menstrua. When given at night for insomnia the medi- 
cine should be taken upon an empty stomach, about one hour 
before sleeping-time. 

Chloral Butylicum— Chloralis Butylici— Butyl- 
chloral Hydrate. 

(Croton-chloral.) 

Origin. — Prepared by passing dry Chlorine Gas into Acetic 
Aldehyde, resulting in the formation of butyl-chloral, which is 
separated by fractional distillation, and Water added. 

Description and Properties. — Butyl-chloral occurs as a heavy, 
colorless oil, having an odor resembling that of chloral. The 
hydrate (croton-chloral hydrate) used in medicine is in the form of 
white scales, of a silky luster, nauseous taste, and a peculiar fruit- 



HYPNOTICS. 447 

like odor. It is freely soluble in alcohol, ether, glycerin, and hot 
water, but not easily soluble in cold water. Its solutions are un- 
stable, and are decomposed if kept on hand even for a short time. 

Dose. — 3-20 grains (0.18- 1.2 Gm.). 

Incompatibles and Synergists are the same as for chloral. 

Its Physiological Action and Therapeutics are quite similar to 
those of chloral, though it is considered less depressing to the 
heart and circulation, while possessing greater anodyne properties, 
having a selective action upon the fifth nerve, doses even of 2 
grains (0.12 Gm.) often producing anesthesia of the trigeminal 
nerve before other actions of the drug are manifest. 

It is therefore superior to chloral as an anodyne and hypnotic 
in headaches, facial neuralgia, tic douloureux, migraine, etc. 

As a simple hypnotic it is feebler and more uncertain in its 
effects than chloral, and, even with its alleged advantages, it is 
doubtful if it will ever supplant that drug to any extent, save in 
cases of neuralgia of the fifth nerve and painfid spasm of the 
face. 

In facial neuralgias a mixture of butyl-chloral and tincture of 
camphor may be applied locally. 

Contraindications. — Hyperemia of the brain, gastro-intestinal 
irritation, and weak heart. 

Administration. — It should be given in pill form or in capsules. 
If given in solution, the bitter taste may be disguised by dissolv- 
ing it in the aromatic elixir or syrup of liquorice. A mixture of 
glycerin, syrup, and peppermint water also serves as a good vehicle. 

Sulphonal— Sulphonal— Sulphonal. 

The chemical name of this drug is diethyl-stdphon-dimethyl- 
methane. 

Origin. — It is prepared by combining Ethyl Hydrosulphide 
(Mercaptan) with Acetone, forming mercaptol, which is oxidized by 
potassium permanganate into sulphonal. 

Description and Properties. — It occurs as colorless, odorless, 
nearly tasteless prismatic crystals ; soluble in 450 parts of cold 
water, in 1 5 parts of boiling water, and in 65 parts of cold or 2 
parts of boiling alcohol. It is a very stable substance, being un- 
affected by concentrated acids or alkalies. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 



448 A TEXT-BOOK OF MA TERIA MEDICA. 

Allied Compounds. 

Trional (Diethyl-sulphon-methyl-ethyl-methane). — Origin. — Prepared ex- 
actly like sulphonal, except that Methyl-ethyl-ketone is used in place of Acetone. 

Description and Properties. — Shining, colorless, odorless, crystalline plates ; freely 
soluble in alcohol, and soluble in 320 parts of water. It is more rapid in its action than 
sulphonal, and comparatively safe. 

Dose. — 10-40 grains (0.6-2.5 Gm.). 

TStronal (Diethyl-sulphon-diethyl-methane). — Origin. — This substance is 
also prepared like sulphonal, differing from the latter in that it contains two additional 
ethyl groups, and, being more poisonous, is consequently more unsafe as a remedy. 

Description and Properties. — Colorless, shining plates and laminae, of bitter taste 
and slightly camphoraceous odor ; soluble in 450 parts of cold and in 5 parts of boiling 
alcohol ; insoluble in water. 

Dose. — 10—40 grains (0.6-2.5 Gm.). 

Antagonists and Incompatibles. — There are none of import- 
ance, and, owing to its insolubility, sulphonal is usually 'given alone. 

Synergists. — Morphine intensifies its hypnotic action. 

Physiological Action. — Externally and Locally, sulphonal has 
no influence. 

Internally. — Digestive System. — In medicinal doses it has no 
effect on the digestive tract. Toxic doses may result in nausea, 
vomiting, and gastric pain. 

Circulatory System. — It has no depressing action on the heart ; 
on the contrary, it is stated by Shick to accelerate the pulse and 
slightly raise arterial tension. 

Nervous System. — Like chloral, it depresses the cerebral cortex, 
but has no influence upon the motor or sensory nerves. Shick 
believes that it stimulates Setschenow's reflex inhibitory centers, 
and to this influence is due the diminished reflex activity occa- 
sioned by the drug. 

It is capable of producing sleep, but its action is very much 
slower than that of chloral, from three to eight hours often elapsing 
between the ingestion of a medicinal dose and its soporific effect, 
the duration of which averages about seven hours. The mental 
disturbance which ensues is greater than in the case of chloral. 
Sulphonal possesses no anodyne properties. 

Respiratory System. — In medicinal doses it is much less depress- 
ing to the respiratory center than chloral, yet when death from 
sulphonal occurs it is usually the result of respiratory paralysis. 

Absorption and Elimination. — Kast alleges that it is slowly sol- 
uble in the gastric juice and gradually absorbed. William J. Smith 
of London, who has experimented extensively with this drug, 



HYPNOTICS. 449 

claims that it is eliminated by the kidneys as ethyl-sulphonic acid. 
It has also been shown that under the administration of large doses 
or prolonged use a small quantity of sulphonal is eliminated as 
such unchanged. Furst states that the greater- portion is excreted 
in the form of soluble sulphates, and that the urine often contains 
traces of albumin and renal elements, wisely suggesting that the 
drug be at once discontinued should there be reason to suspect 
the presence of hematoporphyrin, as indicated by the discoloration 
of the urine. 

Temperature is unaffected by medicinal doses. 

Eye. — Knaggs and Dillingham report cases accompanied by 
affection of the eye, loss of sensation in the conjunctivae, and ptosis 
lasting two weeks. The cause in these instances was sulphonal- 
poisoning. Medicinal doses produce no notable effect upon this 
organ. 

The Untoward Action and Poisoning resulting from the use of 
sulphonal present symptoms of so varied a character that the drug 
seems to possess no properties of a uniformly toxic nature. More- 
over, in the cases of poisoning recorded the condition of the patient 
and the quality of the drug have been such as to require consider- 
able variation in the amount given. In one case 30 grains (2.0 Gm.) 
produced death in forty hours {Med. News, lv. p. 166), while in 
another a man swallowed 3 ounces (96.0 Gm.) of sulphonal, which, 
although resulting in a condition of coma lasting six days, termi- 
nated in recovery {Journ. Amer. Med. Assn., iv. p. 21). 

In general, however, the poisonous effects of sulphonal are 
exerted on the blood and on the nervous system. When large 
doses are taken, unconsciousness, which may persist for long inter- 
vals, is the most prominent symptom. Paralyses, but rarely con- 
vulsions, have been noted. Respiration is at first unaltered, but 
later may become stertorous, shallow, and slow. Cyanosis develops ; 
the pulse is small and irregular. A preliminary fall of temperature 
is followed by a rise, perhaps to 40 C. (104 F.). The kidneys 
may or may not be affected. There may be constipation, or, if 
paralysis of the intestinal musculature has occurred, a diarrhea 
may supervene. Papular exanthemata are not uncommon. 

In individuals who may be taking any of this type of hypnotics 
for any considerable period of time irregular toxic symptoms are 
noted. These consist for the most part of hebetude, sleepiness, 
stupidity, loss of appetite, and muscular weakness ; the frequency 
of the pulse is diminished, and if the poisoning is more pronounced, 

29 



45° A TEXT-BOOK OF MA TERIA MEDICA. 

there may be dizziness, ataxia, and, rarely, hallucinations and 
delirium. The most important symptom is the presence of hema- 
toporphyrinuria, produced by the breaking up of the blood pig- 
ment in the red corpuscles and its appearance in the urine as 
hematoporphyrin, a reduction product of hemoglobin. This gives 
this fluid a peculiar cherry-red color. Its appearance is a signal to 
cease the use of the drug. 

Of the three drugs of this class, trional is perhaps to be pre- 
ferred. Tetronal is not to be recommended. Very persistent 
habits may be contracted by takers of these drugs. 

Treatment of Poisoning. — Discontinuance of the drug ; elimina- 
tive and symptomatic treatment. 

Therapeutics. — Sulphonal is never used externally, and inter- 
nally it is valuable only as a hypnotic — in insomnia unaccompanied 
by pain, and particularly to produce sleep and quiet the intense ex- 
citement of the insane. In the author's opinion, its many disadvan- 
tages, together with its unreliability and uncertainty of action, 
should relegate it to a place greatly inferior to that of chloral or 
any other hypnotic mentioned above. 

Contraindications. — None of importance. 

Administration. — Sulphonal should be given in powder or cap- 
sules or in hot whiskey. Owing to its insolubility, it should not 
be administered in the form of compressed tablets. 

Paraldehydum— Paraldehydi— Paraldehyde. 

U. S. JP. 

Origin. — A polymeric form of Ethylic Aldehyde. 

Description and Properties. — A colorless, transparent liquid, 
having a strong, characteristic, but not unpleasant, pungent odor, 
somewhat resembling that of chloroform, and a burning, cooling 
taste. Soluble in 8.5 parts of water and in 16.5 parts of hot water, 
being, as will be observed, more soluble in the former than in the 
latter. Miscible in all proportions with alcohol, ether, and fixed 
;and volatile oils. 

Dose. — J— 1 fluidrachm (1.0-4.0 Cc). 

Unofficial Preparation. 

Elixir Paraldehydi — Elixir Paraldehydi — Elixir of Paraldehyde. — Dose, 1- 
2 fluidrachms (4.0-8.0 Cc). 

Synergists. — Opium and the hypnotics aid its action. 



HYPNOTICS. 451 

Physiological Action. — Extertially and Locally. — Antiseptic, 
antifermentative. 

Internally. — Digestive System. — Paraldehyde has no action upon 
the digestive tract. 

Circulatory System. — It differs from chloral in affecting the cir- 
culatory system favorably in medicinal doses, tending rather to 
slow and strengthen the pulse. Toxic doses weaken the heart and 
lower arterial pressure, the heart's action ceasing in diastole. 

Nervous System. — Its influence upon the brain and spinal cord 
is similar to that of chloral. The sleep it induces, however, is not 
so prolonged as that caused by the latter drug, more frequent doses 
being required for continued soporific effects. The sequelae of 
paraldehyde are not unpleasant. 

Respiratory System. — Its action resembles that of chloral, al- 
though it is not so powerful a respiratory depressant. In toxic 
doses death usually ensues from paralysis of the respiratory center. 

Absorption and Elimination. — Paraldehyde is eliminated by the 
lungs and kidneys. 

Temperature. — Like chloral, it lowers the temperature, but in 
less degree. 

Untoward Action. — It occasionally causes irritation of the 
mucous membranes and erythematous eruption. 

Poisonmg. — The symptoms of poisoning are similar to those of 
chloral. Fatty degeneration of the heart and liver have been found, 
together with disorganization of the red corpuscles. 

Treatment of Poisoning. — The same as in poisoning from chloral. 

Therapeutics. — Like those of chloral. Paraldehyde is more 
hypnotic than anodyne, appearing to be best adapted to relieve so- 
called idiopathic insoinnia. It is a better diuretic than chloral, and 
in certain degenerated conditions of the heart and arteries, where a 
diuretic as well as hypnotic is desirable, paraldehyde serves as a 
valuable remedy. 

Cervello has recommended it highly in strychnine-poisordng, 
and several cases of its successful use in tetanus are reported. 

Administration. — It may be given in capsules, or, when other- 
wise administered, its unpleasant taste may be disguised by giving 
it in an emulsion flavored with orange or bitter almond. Glycerin 
also renders it quite palatable, yet it is always more disagreeable to 
the taste than chloral, besides lending to the breath an offensive 
and persistent odor. 



452 A TEXT-BOOK OF MATERIA MEDICA. 



GROUP V.— NARCOTICS. 

Opium— Opii— Opium. U.S. IP. 

Origin. — The concrete, milky exudation obtained by incising 
the unripe capsules of Papaver somniferum (L.), the substance in 
its normal moist condition yielding not less than 9 per cent, of 
crystallized morphine when assayed. 

The poppy from which opium is derived is indigenous in West- 
ern Asia and cultivated in Egypt, Persia, Asia Minor, the elevated 
plains of India, and in some parts of Europe. 

Description and Properties. — Opium appears in irregular or 
subglobular cakes — with the remnants of poppy-leaves and the 
fruit of a species of Rumex adhering to their surfaces — plastic or 
of a harder consistence, chestnut-brown or darker, and somewhat 
shining internally, showing tears, and fragments of vegetable tissue. 
It has a sharp, narcotic odor and a peculiar, bitter taste. This de- 
scription applies to the Smyrna, Levant, Turkey, and Constantinople 
opium. There are, however, five other varieties — viz. 1. Egyptian, 
flattened, roundish cakes ; 2. Persian, black, cylindrical sticks, or 
small cakes or balls, wrapped in paper; 3. Indian, flat squares 
covered with mica and wax or an oiled paper wrapper ; 4. Chinese, 
oblate-spheroidal masses wrapped in white paper; 5. European. 

Opium contains about twenty different alkaloids, either in a 
free state or in combination with some acids. The principal alka- 
loids, in the order of their medical importance, are morphine, 
codeine, narceine, and thebaine ; others are narcotine, papaverine, 
cryptopine, pseudomorphine , protopine, hydrocotarnifie, laudanine, 
cadamine, rheadine, meconidine, laudanosine, lanthopine, gnoscopine, 
and oxynarcotine. 

The following constituents of opium are in some respects im- 
portant : Meconic acid, meconin, meconoiosin, and porphyroxin. 

In addition to the above, opium contains these substances, 
making it one of the most complex drugs in Materia Medica : 
Mucilage, resin, fats, essential oil, glucose, caoutchouc, ammonium, 
calcium, and magnesium salts, and odorous and coloring matters, 
besides certain impurities and adulterants, such as stones, fruits, 
leaves, starch, water, lead, etc. 

Dose. — J-2 grains (0.015-0. 12 Gm.). 



NARCOTICS. 453 

Official Preparations. 

Opii Ptilvis— Opii Ptilveris — Powdered Opium. — Dose, %-2 grains (0.015- 
0.12 Gm.). 

Powdered opium should yield not less than 13 nor more than 15 per cent, of crys- 
tallized morphine. 

Acetum Opii (10 per cent.) — Aceti Opii — Vinegar of Opium. — Dose, 3-15 
minims (0.18-1.0 Cc). 

Extr^ctum Opii (18 per cent, of morphine) — Extralcti Opii— Extract of Opium. 
— Dose, \-i grain (0.01-0.06 Gm.). 

Empl&strum Opii (6 per cent, of extract of opium) — EmplSstrum (ace.) Opii — 
Opium Plaster. — For external use. 

Formula: Extract of Opium, 60; Burgundy Pitch, 180; Lead Plaster, 780 ; 
Water, 80. 

Opium Deodoratum (13 to 15 per cent, of morphine) — Opii Deodorati — De- 
odorized Opium (Denarcotized Opium). — Dose, £-2 grains (0.015-0.12 Gm.). 

Pilulae Opii (1 grain, or 0.06 Gm., in each pill) — Pilulas (ace.) Opii — Pills of 
Opium. — Dose, I or 2 pills. 

Piilvis Ipecacuanhas et Opii — Ptilveris Ipecacualnhae et Opii — Powder of 
Ipecac and Opium (Dover's Powder). — Dose, 5-10 grains (0.3-0.6 Gm.). 

Formula: I grain (0.06 Gm.) Opium, 1 grain (0.06 Gm.) Ipecac, 8 grains (0.5 Gm.) 
Sugar of Milk, in every 10 grains (0.6 Gm.). 

Tinctura Opii (10 per cent.) — Tincturae Opii — Tincture of Opium (Laudanum). 
— Dose, 5-15 minims (0.3-1.0 Cc). 

13 minims (0.78 Cc.) represent about 1 grain (0.06 Gm.) of Opium. 

Tinctura Opii Camphorata — Tincturae Opii Camphoratae — Camphorated 
Tincture of Opium (Paregoric). — Dose, \-\ fluidrachms (2.0-15.0 Cc). 

Formula: Powdered Opium, 4; Benzoic Acid, 4; Camphor, 4; Oil of Anise, 4; 
Glycerin, 40; Diluted Alcohol, to 1000. Prepared by maceration and percolation. 
4 fluidrachms (15.0 Cc) represent about I grain (0.06 Gm.). of Opium. 

Tinctura Opii Deodorati (10 per cent.) — Tincturae Opii Deodorati — Tincture 
of Deodorized Opium. — Dose, 5-15 minims (0.3-1.0 Cc). 

Tinctura Ipecacuanhae et Opii — Tincturae Ipecacuanhae et Opii — Tincture 
of Ipecac and Opium (Tincture of Dover's Powder). — Dose, 5-15 minims (0.3- 
1.0 Cc). 

10 minims (0.6 Cc.) contain I grain (0.06 Gm.) each of Opium and Ipecac. 

Trochisci Glycyrrhizae et Opii — TrocMscos (ace) Glycyrrhizae et Opii — 
Troches of Liquorice and Opium. — Dose, I to 3 troches. 

Each troche contains about T 2 ^ grain (0.005 Gm.) of Opium. 

Vinum Opii (10 per cent.) — Vini Opii — Wine of Opium. — Dose, 5-15 minims 
(0.3-1.0 Cc). 

The Description and Properties of the official alkaloids of opium and their salts are 
as follows : 

Morphlna — Morphinae — Morphine. — Colorless or white, shining, prismatic 
crystals, or fine needles, or a crystalline powder, odorless, having a bitter taste, per- 
manent in the air. Soluble in 4350 parts of water, in 300 parts of alcohol, in 455 parts 
of boiling water, and in 36 parts of boiling alcohol. Dose, \-\ grain (0.008 -o.oi 5 
Gm.). 

Morphinae Acetas — Morphinae Acetatis— Morphine Acetate. — A white or 
faintly yellowish-white, crystalline or amorphous powder, having a faint, acetous odor 
and a bitter taste. Soluble in 2.5 parts of water and in 47.6 parts of alcohol. On pro- 



454 A TEXT-BOOK OF MATERIA MEDICA. 

tracted exposure to the air the salt gradually loses some acetic acid, becoming less 
soluble. It should be kept in dark amber-colored, well-stoppered bottles. Dose, \-\ 
grain (0.008-0.0 1 5 Gm.). 

Morphinae Hydrochloras — Morphinae Hydrochloratis — Morphine Hydro- 
chlorate. — White, feathery needles, of a silky luster, or minute, colorless, cubical 
crystals, odorless, having a bitter taste, permanent in the air. Soluble in 24 parts of 
water and in 62 parts of alcohol. Dose, \-\ grain (0.008-0.015 Gm.). 

Morphinae Sulphas — Morphinae Sulphatis — Morphine Sulphate. — White, 
feathery, acicular crystals, of a silky luster, odorless, of a bitter taste, permanent in air. 
Soluble in 21 parts of water and in 702 parts of alcohol. Dose, \-^ grain (0.008- 
0.015 Gm.). 

Codeina — Codeinae — Codeine. — White or nearly translucent, orthorhombic 
prisms, or octahedral crystals, odorless, having a faintiy bitter taste, and slightly efflores- 
cent in warm air. Soluble in 80 parts of water and in 3 parts of alcohol. Dose, \- 2 
grains (0.03-0.12 Gm.). 

Various salts of codeine are in use, the sulphate being the most important. 

Official Preparations of Morphine Sulphate. 

Ptilvis Morphinae Compositus — Piilveris Morphinae Compftsiti — Com- 
pound Powder of Morphine (Tully's Powder). — Dose, 5-15 grains (0.3-1.0 Gm.). 

Formula: Morphine Sulphate, I; Camphor, 19; Glycyrrhiza, 20; Precipitated Cal- 
cium Carbonate, 20 ; Alcohol, q. s. to 60. 

Trochlsci Morphinae et Ipecacuanhas — Trochiscos (ace.) Morphinae et 
Ipecacu&nhae — Troches of Morphine and Ipecac. — Dose, 1 to 5 troches. 

Formula: Morphine Sulphate, 0.16; Ipecac, 0.50; Sugar, 65; Oil of Gaultheria, 
0.2 ; Mucilage of Tragacanth, a sufficient quantity to make 100 troches. Each troche 
contains about -^ grain (0.0015 Gm.). 

Antagonists and Incompatibles of Opium and its Alkaloids. 

— The physiological antagonists are atropine, strychnine, coffee or 
caffeine. Quinine antagonizes some of the cerebral effects -of the 
drug, while tartrate of antimony and potassa (tartar emetic) and 
digitalis oppose its action on the intracranial circulation. The 
incompatibles are alkalies, tannic acid and infusions containing it, 
and salts of lead, iron, copper, mercury, and zinc. 

The following are incompatible with morphine and its salts : 
iodine and iodides, bromine and bromides, Fowler's solution, 
and sodium borate. 

Synergists. — The hypnotic action of opium is aided by the 
hypnotics ; its anodyne influence is enhanced by belladonna and 
cocaine, and its sudoriferous effects by ipecacuanha. 

The Physiological Action of opium differs in some respects 
from that of morphine or codeine, and will therefore be described 
first. 

Externally and Locally. — Applied to the unbroken skin, opium 
possesses feeble analgesic properties, and from mucous membranes 



NARCOTICS. 455 

or raw surfaces it is readily absorbed, producing marked anodyne 
effects. 

Internally. — Digestive System. — Its prominent action is upon the 
secretions — checking that from the salivary glands', causing great 
dryness of the mouth and consequent thirst — largely diminishing 
those from the stomach, and reducing the bile and pancreatic juice 
secreted. In fact, every secretion in the body is lessened except 
the perspiration, the cause being the depressing influence of the 
drug upon the secretory centers in the medulla. It may be added 
that the peristaltic movements of the digestive apparatus are re- 
duced, which, together with diminished secretions, impairs diges- 
tion and produces constipation. 

The action upon the intestines, however, varies with the dose 
administered, moderate or full medicinal doses checking peristalsis 
and promoting constipation. On the other hand, very large or very 
small doses increase peristalsis, the former augmenting this effect, 
and producing violent movement of the bowels through the drug's 
paralyzing action upon the splanchnic inhibitory fibers of the intes- 
tine, so that inhibition is removed and peristalsis reinforced. Very 
small doses act as purgatives when by some reflex disturbance, 
such as a tender ovary, the peristalsis is inhibited. Minute quanti- 
ties, by partially benumbing the inhibitory nerves or diverting 
the stimulus from them to the stimulating fibers, relieve consti- 
pation. This action is rendered serviceable in the similar con- 
stipation accompanying lead-poisoning, the metal constipating the 
patient not only by its astringent action, but also by the tetanic 
spasm of the intestines caused by the irritating action of the lead 
upon their mucous membrane. The feces are held by spasmodic 
intestinal contraction, relief of which by a small dose of opium, 
sufficient to induce peristalsis, will be followed by evacuation. 

Circulatory System. — Small doses accelerate the pulse, render- 
ing it fuller and firmer, and dilate the arterioles, though increasing 
arterial tension. This action is due to stimulation of the vaso- 
motor mechanism of the circulatory apparatus. Large doses, while 
primarily quickening, soon retard the heart's action, rendering the 
pulse full. This influence is occasioned by stimulation of both 
ends of the vagus. Should the dose be lethal, the pulse may 
become rapid and weak from over-stimulation, and consequent ex- 
haustion, of the vaso-motor center and pneumogastric nerves. 

Nervous System. — Opium seems to act differently upon the 
brain and the spinal cord. Upon the former it produces a tempo- 



456 A TEXT-BOOK OF MATERIA MEDIC A. 

rary period of excitement, varying in duration according to the 
size of the dose administered, small doses greatly stimulating the 
imaginative faculty. The state of excitation is followed by depres- 
sion, soon yielding to easily disturbed sleep, frequently disturbed 
by dreams, which may be of a pleasant, voluptuous character or 
disagreeable and hideous, the condition of the patient at this time 
varying with the dose he has taken — all occasioned by removal of 
the inhibition from the reflex centers. If it has been sufficient to 
produce profound stupor, the patient is insensible to sound, light, 
or external irritation. Pain is abolished, and the reflexes transmit 
no impression. On waking the patient complains of headache, a 
feeling of languor, vertigo, nausea, and constipation. 

Opium first stimulates and afterward depresses the higher cen- 
ters, the same action being subsequently manifested in the lower 
centers. 

The cerebral exhilaration is doubtless the result of an increased 
blood-supply to the brain, while the sleep and mental depression 
are due to the direct sedative action of the drug upon the cortical 
cells of the brain. 

Pain is relieved by opium through its depressing influence upon 
the entire sensory apparatus, the peripheral ends of the sensory 
nerves, the conducting path in the spinal cord, and the receiving 
cerebral center all being similarly affected by opium, rendering the 
drug one of the most powerful analgesics known. 

Respiratory System. — In very small doses opium slightly stim- 
ulates respiration ; in full or large doses it is a strong respiratory 
depressant, its action being upon the center in the medulla. Death 
is usually caused by paralysis of respiration. 

Absorption and Elimination. — Opium is rapidly absorbed, and is 
eliminated chiefly by the gastro-intestinal mucous membrane and 
very little by the kidneys. 

Moderate quantities of the drug are oxidized in the body, 
though when large doses are administered opium may be found 
unchanged in the urine. It is also excreted in the bile, in the 
milk, and to some extent in the sweat, which is largely increased 
by Opium, particularly when the drug is combined with ipecacu- 
anha, as in Dover's powder. The sweat is the only secretion aug- 
mented by opium, although the manner in which the sudoriparous 
glands are stimulated is not positively known — whether centrally 
or peripherally. Probably the action is due to increasing venosity 
of the blood stimulating the sweat-centers in the spinal cord. 



NARCOTICS. 457 

The reabsorption of opium may be prevented by frequently 
washing out the stomach, from which viscus the drug is mainly 
eliminated. Catheterization is also indicated from time to time to 
assist elimination. 

Temperature is at first raised, but later lowered when free 
diaphoresis is established. 

Eye. — The pupils are minutely contracted by large doses, the 
modus operandi not being fully understood, though probably the 
action is due to stimulation of the oculo-motor center. The pupil 
usually dilates just before death from opium-poisoning, owing 
either to paralysis of the oculo-motor center or depression of the 
sympathetic fibers, and, perhaps, excessive venosity of the blood. 
Untoward Action. — Headache, disturbances of hearing, muscular 
tremor or temporary paralysis, itching of the skin with or without 
eruption. In case the latter symptom appears, it is commonly in 
the form of small red spots resembling roseola. An erythematous 
inflammation may affect the mucous membrane of the mouth and 
throat. 

Morphine has produced paresthesia of the sense of taste, as 
well as spasm of accommodation of the eye and edema of the 
eyelids. Many other untoward manifestations occur, even under 
minute doses, in persons having an idiosyncrasy against the drug. 
Poisoning. — Small medicinal doses of opium, as we know, tend 
to produce moderate excitement, a pleasing sense of freedom from 
care, and, in sleep, tranquil, even happy, dreams. Far otherwise it 
is with toxic doses. Under their influence the entire physiological 
conditions of the system are perverted. Here the drug exerts its 
baneful effects, and the mind rapidly succumbs to a power over 
which it has no control. The period of excitement is absent, the 
predominating desire of the patient being to sleep, and from the dull, 
lethargic stupor which supervenes he is roused only by vigorous 
and unremitting treatment. Giddiness portends this mental and 
physical state. The pulse, though still full, diminishes in fre- 
quency; the breathing becomes heavy and labored, and finally 
stertorous ; the heart is now apparently seized with indefinable 
oppression, and the pupils are visibly contracted ; the skin is dry 
and warm, and the face suffused or at length of a marked cyanotic 
hue, cutaneous eruptions being not uncommon. Should relief be 
not forthcoming, the pulse continues to sink ; the drowsiness and 
subsequent lethargy are followed by a state of true coma ; the 
muscular system is wholly relaxed; the reflexes are obliterated, 



458 A TEXT-BOOK OF MA TERIA MEDICA. 

and death ensues from respiratory failure, the asphyxia being 
closely accompanied by cessation of the heart's action. 

Although this stage of toxemia is not necessarily fatal, it will be 
readily seen that its alarming manifestations demand the utmost 
skill and vigilance on the part of the physician. In fact, the diag- 
nosis is not always clear, the phenomena so nearly resembling 
those of alcoholism, especially apoplexy, uremia, and congestion 
of the brain, that it is at times next to impossible to predicate from 
symptoms alone the presence of opium-poisoning. It may be ob- 
served, however, that, save in certain exceptional cases, contraction 
of the pupil is wanting in apoplexy, while there is present partial 
distortion of the face or paralysis of the limbs. From uremia 
opium-poisoning is differentiated by the presence in the former of 
edema and by albumin and casts in the urine. 

The treatment of acute opium-poisoning covers an ample field 
of therapeutic experience, the remedies employed being numer- 
ous, and in their physical properties often widely diverse. 
Three objects are of paramount necessity : to evacuate the 
stomach, maintain respiration, and prevent failure of circulation. 
The first of these may be attained by the use of the stomach- 
pump or siphon-tube (easily improvised). Active stimulants and 
irritating emetics are of great service, the latter being assisted 
by frequent and copious draughts of warm water in the intervals 
of vomiting, and the doses being large in order to make an im- 
pression upon the insensibility of the stomach. Various agents, 
including chemical antidotes, may aid recovery — tannic acid, per- 
manganate of potassium, strychnine especially, atropine, strong 
black coffee, hypodermic injections of apomorphine, etc. — and other 
resources have been tried with varying success. Warm water in- 
jected into the rectum and stomach has proved efficacious. Coun- 
ter-irritants, flagellation, shouting in the ear, may rouse the patient 
from his lethargy. Should artificial respiration become necessary, 
either Sylvester's method or the use of the faradic current can be 
adopted. It is here of great importance that the subject should be 
kept awake, that he may voluntarily assist in the recuperative pro- 
cess, which while the will is quiescent in sleep he is unable to do. 
The full force of the faradic battery may be used, but it should 
never be applied to the phrenic nerve directly, lest paralysis of the 
cardiac muscles ensue. Should the bodily temperature fail to be 
sustained, external heat should be employed to supply the de- 
ficiency. 



NARCOTICS. 459 

In maintaining the circulation strychnine and atropine, both 
powerful antidotes to opium, will be of great value. Rubbing, 
massage, flagellation — but never such as to produce exhaustion — 
and, if necessary, moderate venesection, may be used as supple- 
mentary efforts at restoration. Walking the patient will often ward 
off somnolence, the exercise being continued until thorough wake- 
fulness results, provided there be no untoward muscular debility. 
Inhalations of ammonia have proved efficacious, and the use of the 
catheter has been found to stimulate excretion by the kidneys. 
Special efforts should be directed, however, toward sustaining 
respiration, since failure in this respect is most to be feared. 
Should the breathing be normally resumed, or even partially so, 
there is no special danger to be apprehended from the state of 
coma. Cerebral effects have sometimes been relieved by quinine. 
The use of atropine is not to be encouraged, save in exceptional 
cases — and then without repetition — since it may prove irritating to 
the cardiac ganglia, while continued doses are liable to induce 
belladonna-poisoning, as dangerous as the original condition. 

In the choice of remedies it should be borne in mind that the 
influence of opium is limited to the nervous system, and that 
lethal doses tend to cause paresis of the arterioles and veins. 
Each case, moreover, is to be studied individually, scarcely any 
drug being more dependent than opium upon the idiosyncrasies of 
the patient. 

Chronic opium-poisoning, resulting from the habitual use of 
opium, its most active constituent morphine, or its salts, is undoubt- 
edly one of the most pernicious habits to which the human system 
can be subjected, its mental, moral, and physical phenomena being 
among the saddest and most terrible known to therapeutics. 

The symptoms of this disease of mind and body are in some 
respects similar to those of acute opium-poisoning in their physio- 
logical aspect, but the psychological features of the malady are 
more abhorrent and less amenable to treatment. Extreme nervous- 
ness and tremors ; abnormal exercise of cerebral functions, mani- 
fested in extraordinary hallucinations ; hypochondria ; anxiety ; 
insomnia; spasms and painful neuralgia; and not infrequently 
suicidal intent or mania, — these are among the prominent charac- 
teristics which mark the victim of the opium habit. The physio- 
logical symptoms include dryness of the tongue ; vesical irritation, 
with possibly excessive urinary discharge ; constipation ; serious 
disturbances of the sexual function, resulting in impotence or sus- 



460 A TEXT-BOOK OF MA TERIA MEDICA. 

pension of catamenia ; while caries of the teeth is also sometimes 
present, — the derangement of the system being wellnigh com- 
plete, often beyond the reach of therapeutic aid. In the words of 
a votary to the habit, " My head throbs like a trip-hammer ; my 
teeth are set ; a metallic taste is in my mouth ; my face, neck, and 
arms are red as fire, and all the veins swollen. Worst is the 
throbbing in my head." 

The conditions inducing the opium-habit are frequently caused, 
or are largely influenced, by the therapeutic employment of the 
drug — as was the case with De Quincey, whose graphic analysis 
of the Pleasures and Pains of opium, if possibly to be taken cum 
grano salts, is at once the most powerful and the most eloquent 
ever written. The patient who has once experienced the anodyne 
influence of the drug — as captivating to his senses as though it 
were a draught of fabled Lethe — readily yields to it upon the 
slightest occasion, as, for instance, to alleviate trivial indispositions 
for which, in ordinary circumstances, he would ridicule the idea of 
medical treatment. With repeated indulgence — often promoted by 
a casuistic reasoning of which by degrees the subject is scarcely 
conscious, or by persistent and intentional deception — comes the 
craving which knows no restraint, and which can be quieted only 
by complete mental and physical regeneration or the merciful re- 
lease of death. Dependent for fancied happiness upon his ex- 
traneous resource, the blind idolater of personal ease pursues his 
ignis fatuus heedless of consequences, in his mental and moral 
degeneracy apparently lost to all finer feeling or to manlier resist- 
ance in presence of his insidious, blighting temptation. Mean- 
while, physiological torpor demands an ever-increasing amount of 
the drug that the system may be sufficiently impressed. Psychical 
emotions, anxiety, anger, mental anguish, or, indeed, the most 
puerile pretexts, continue to furnish occasion for indulgence, and 
the facilities of administration afforded by the modern method of 
hypodermic injection unhappily serve to stimulate a longing for 
momentary exhilaration or the alluring oblivion which may oblit- 
erate the past, but which reason cannot suffer to ignore the future 
when the mind recalls the overwhelming testimony of experience. 

Should amelioration be now attempted and the drug withheld, 
more distressing symptoms still are developed. Depression and 
exhaustion are manifested at once, followed by increasing melan- 
cholia, attended by horrible visions and anxieties no mental energy 
— such as remains of it — can dispel. The pulse is scarcely percepti- 



NARCOTICS. 461 

ble ; the patient is in a state of nervous tension, occasionally evinced 
by paroxysms of despair ; and in the deprivation endured the poor 
wretch, with outstretched hands and imploring expression, begs, 
screams, for morphine, laudanum, or other habitual form of opium, 
at last breaking down utterly in a fit of passionate weeping when 
denied the solace craved. It is, indeed, an appalling spectacle of 
human misery which, could it be witnessed by those in whose 
imaginations the first subtle effects of opium awaken dreams of 
elysium, might well persuade the victim to forswear a gratification 
for which so tragic a fate is reserved. 

The treatment of so dire a malady — for such the chronic use 
of opium must be regarded — demands the utmost forethought, 
patience, and tact. The method of sudden, absolute withdrawal 
of the drug is admitted by the wisest observers to be fraught with 
danger commensurate with that of the indulgence to be overcome. 
Collapse, insanity, and other serious results have attended so dras- 
tic a measure, the general opinion obtaining to-day being that a 
gradually reduced dose of the drug is the safest and most rational 
mode of procedure. The conditions are extremely difficult to 
combat successfully, repeated hypodermic injections being eradi- 
cated from the system far less readily than opium from the stom- 
ach. The moral nature of the patient, too, has become so per- 
verted that little or no reliance can be reposed in his veracity, the 
physician being thrown upon his unaided resources, supplemented 
by the untiring vigilance and fidelity of the attendant. 

The gravity of the situation should from the first be fully real- 
ized, since it is too often simply a case of life or death, the patient 
being not infrequently seized with the desire of self-destruction in 
the extremity of mental anguish occasioned by the ordeal imposed 
by unwonted abstinence. Could he be put upon his honor, and 
that honor be steadfast, his co-operation would be invaluable. But 
this assistance is seldom at command, the patient's loyalty of pur- 
pose and unswerving resolution, as professed, being wholly sub- 
servient to a volition long since weakened, if not annihilated, by 
pitiful sophistries and moral degradation. Nevertheless, the case 
must be approached from the sympathetic side, and every means 
of inspiring confidence employed, remembering that a human will 
as well as body is under treatment, and that mental sanity as well 
as physiological health is to be restored. 

Of the many agents suggested by therapeutic science, valerian- 
ate of ammonia, fluid extract of coca or camellia, judicious tonics, 



462 A TEXT-BOOK OF MATERIA MEDICA. 

easily digested and strengthening food, and, if necessary, alcoholic 
stimulants, have been especially beneficial. Other remedies, such 
as dilute phosphoric acid, tincture of lupulin, codeine, trional, co- 
nium, and cannabis Indica, have in many cases proved efficient. 

Change of scene, a healthful, stimulating diet, and abundant 
out-door exercise — always favorable to diversion of thoughts — 
seldom fail to react encouragingly upon the mind and physique of 
the patient. The exhibition of symptomatic remedies not indicated 
has been authoritatively condemned, the primary object of treat- 
ment being not so much to afford temporary relief of pathological 
conditions as to remove the dominating cause. Cocaine has also 
been discouraged, lest its use generate habitual desire for the drug. 
In conclusion, it may be said that the obstacles attending a com- 
plete mastery of the opium habit by means of therapeutic resources 
are apparent from the fact that but a small proportion of patients 
addicted to the use of morphine are permanently cured. Yet, though 
the admission be made with regret, it is no disparagement to pro- 
fessional science nobly directed, and assuredly carries with it a 
fearful warning to those who are tempted to seek immunity 
from mortal ills by purblind indulgence in so fatal a medium of 
relief. 

Therapeutics. — In a general way, the medical uses of opium 
are — 1, to relieve pain ; 2, to produce sleep; 3, to lessen reflex irri- 
tation ; 4, to diminish secretion ; 5, to support the system ; 6, to act 
as a sudorific. 

Opium is the most important and useful drug known to medi- 
cine, as well as the most remarkable in its multifarious applications. 
It would, therefore, be idle — indeed, wellnigh impossible — to enu- 
merate all the maladies and abnormal conditions for which this 
invaluable remedy has been employed. It perhaps best represents 
the typical symptom medicine, being used almost invariably for the 
relief of one or more symptoms of disease, rather than for its spe- 
cific or direct curative action upon the disease itself. Unless some 
special contraindication exists, it may be employed when any of the 
above medical uses are desired. 

Externally and Locally. — It is used to relieve pain, either in the 
form of an ointment, a liniment, or a suppository, an aqueous solu- 
tion of morphine sulphate as a collyrium in conjunctivitis, in the 
form of bougies, injections, snuff, or lozenges, or solution in diseases 
of the genito-urinary tract, the ear, nose, and throat. 



NARCOTICS. 463 

Tincture of opium is frequently added to flaxseed poultices to 
allay the pain of superficial inflammation. 

Internally. — Either opium or morphine may be usecj for the 
relief of pain, regardless of the seat or cause. Pain of moderate 
intensity may often be allayed by other anodynes, such as anti- 
pyrine, exalgin, etc. ; but when it is severe or excruciating, it is 
useless to experiment with other drugs when so potent an agent 
for relief as opium is obtainable. 

It is not recommended for ordinary use to produce sleep, because 
of its seductive, insidious action and the danger of creating in the 
patient a tendency toward the opium habit. When, however, sleep- 
lessness is occasioned by pain, and in the insomnia of delirium 
tremens or acute mania, opium or some one of its preparations is 
often an indispensable remedy. 

Spasmodic conditions of involuntary muscles, as in cases of 
asthma, the convulsions of tetanus, uremia, hydrophobia, chorea, etc., 
frequently call for a drug as powerful as opium. 

The paroxysms of periodical fevers, and especially the co?tgestive 
chills of virulent malaria, often yield more readily to this medicine 
than to quinine. 

In dysentery, cholera morbus, and cholera it has been used with 
excellent results, having also been employed in many cases of 
excessive secretion in other portions of the body. 

Opium is frequently given in bronchitis with profuse secre- 
tion and irritable cough, in which condition it acts favorably 
through depression of the reflexes and power to allay irritation 
and check secretion. In these cases, however, small doses only 
should be administered, and the condition of the patient carefully 
watched, especially that of the aged, lest the respiratory apparatus 
be so depressed that expulsion of the accumulated viscid mucus be 
impossible and danger of death from suffocation ensue. 

As a supporter of the system when the vital forces are weak- 
ened by acute or chronic disease or injury there are but few drugs 
as efficacious as opium. It calms and strengthens the debilitated 
heart, and secures to the patient refreshing sleep, soothing and in- 
vigorating his system by means of the much-needed rest. If pain 
be persistent, wearing seriously upon the sufferer's vitality, opium 
by its anodyne influence enables him to recuperate during the 
interval of relief. 

When given in proper doses in peritonitis, opium reduces peri- 
stalsis and removes the pain, promoting the patient's comfort and 



464 A TEXT-BOOK OF MATERIA MEDICA. 

supporting his vital powers. It diverts the blood from the con- 
gested peritoneum by dilating the cutaneous blood-vessels. Fur- 
thermore,, it possesses the peculiar property of causing the irrita- 
tion in the inflamed area to contract reflexly the local blood-vessels, 
thus diminishing the blood-supply to the diseased part. 

It is manifestly of little service ; beyond its pain-relieving effects, 
in the peritonitides of septic appendicitis or of other acute bacterial 
peritonitides. 

In shock from severe injury, opium, by benumbing sensation 
and depressing the reflex mechanism, lessens the danger of cardiac 
and respiratory failure. 

In pleurisy it is the most efficient remedy, relieving congestion 
as in peritonitis, besides reducing the respirations, and consequently 
the friction of the inflamed pleural surfaces, as well as allaying the 
pain accompanying each respiration. 

Dover's powder is a common and valuable agent in acute coryza, 
it also being one of the most efficient diaphoretics. 

Opium is considered the most efficacious remedy in puerperal 
septicemia. It has also been advocated for hemorrhage, both active 
and passive, its greatest utility being manifested in the latter 
condition. 

Although frequently used in continued fevers of various kinds, 
it is indicated as a rule only during their course — or, rather, after 
the fever is well established or during its decline — to mitigate its 
violence or conserve the strength and relieve the nervous manifes- 
tations foreboding exhaustion. Clinical experience has demon- 
strated its inutility, ordinarily, at the onset or climax of such fevers. 
Even in exanthematous fevers opium has proved valuable when the 
eruption is delayed. 

As already intimated, the space allotted to this drug will scarcely 
permit an enumeration of the many disorders for which this remedy 
has been successfully administered. The independent and thought- 
ful physician, knowing the chief indications for its use, will find no 
difficult)/ in employing opium alike to the relief of the patient and 
his own satisfaction. 

Contraindications. — If avoidable, opium should not be given 
to children under five years of age. Should the necessity of ad- 
ministration under that age be deemed advisable in the judgment 
of the physician, it should be remembered that the drug acts with 
greatly disproportionate power upon the nervous systems of the 
young, 1 minim (0.06 Gm.) of tincture of opium having caused the 



NARCOTICS. 465 

death of a child one day old, and a few drops of camphorated tinc- 
ture of opium having proved fatal to an infant of nine months. 
The death is even recorded of a nursing babe, from the mother 
having taken a medicinal dose of laudanum. 

Opium is contraindicated in excessive bronchial secretion of the 
aged during the second stage of pneumonia, in cerebral conges- 
tion, and in alcoholism. 

Administration. — As has been stated under Poisoning, there are 
many circumstances which modify the action of opium, the young 
and the old requiring smaller doses and great care in administra- 
tion. For children the best preparation is paregoric. Females, 
moreover, need smaller doses than males, since they are more 
readily affected by the drug and more subject to untoward mani- 
festations, such as nausea, headache, etc. 

Caution should be exercised in administering opium to those 
who have an idiosyncrasy against it. On the other hand, persons 
addicted to the opium habit require enormous doses to make a 
medicinal impression. 

Agonizing pain seems to antagonize the drug, so that in peri- 
tonitis or during the passage of biliary or renal calculi, in severe 
neuralgia, tic douloureux, etc., opium is well borne, doses which 
under other conditions might produce dangerous symptoms having 
little effect save to deaden the pain, frequently not even inducing 
sleep. 

In other cases, such as nephritis, very small doses may be fol- 
lowed by serious and alarming consequences, continued adminis- 
tration resulting in an accumulation of the drug in the system, 
owing to defective elimination. Should prolonged administration 
be desirable, it is necessary to increase the dose gradually in order 
to produce the requisite effect, because of the growing insensibility 
to the drug. 

Certain preparations are preferable in given conditions. Thus, 
if it be necessary to produce diaphoresis, Dover's powder or some 
other combination with ipecac is advisable. When relief of pain, 
unless it be intense, is desired, small doses of morphine or tincture 
of opium will usually be sufficient, full doses being required to 
produce sleep. 

The deodorized tincture of opium causes less disagreeable 
symptoms than the plain preparation, which contains narcotine. 
Potassium bromide is said to prevent untoward after-effects. 

When opium is demanded for its astringent action, it should be 

30 



466 A TEXT-BOOK OF MATERIA MEDIC A. 

given in small or stimulant doses or combined with chalk or with 
some of the astringents. The camphorated tincture, owing to the 
camphor it contains, is probably the most astringent liquid prepa- 
ration of opium, and is therefore preferable in cases of diarrhea, as 
it is the favorable form as an adjunct to cough-mixtures. 

When the prolonged sedative and astringent effect of opium is 
desired, as in intestinal hemorrhage, diarrhea, nausea, and certain 
diseases of the stomach, an old, dry opium pill or pill of opium and 
lead is better than any liquid preparation or morphine, owing to its 
tardy solution. 

In diseases of the rectum requiring opium a suppository con- 
taining the extracts of opium and belladonna is perhaps the best 
combination to use. 

Ovarian and pelvic pain more readily succumbs to the anodyne 
action of codeine than distress in other parts of the body. 

When opium is used as a soporific, it is best to combine it with 
chloral, a small dose only of each being necessary. These unite 
in their action upon the brain, depressing the heart less than if 
chloral alone had been given, and attended by less serious after- 
effects than had morphine been the sole agent employed. 

Opium prolongs the narcotic effect of chloroform, and in cer- 
tain operations it is good practice to administer a dose of the drug, 
following it soon with a few inhalations of the anesthetic. 

The hypodermic injection of morphine is usually preferable to 
the internal administration of opium in cases of severe pain, since 
a smaller dose is required and a much more rapid effect produced^ 
with less danger of affecting the appetite and bowels. 

The many circumstances influencing the action of the drug 
appear to confirm the statement that " there is no dose of opium/' 
its conduct being wholly dependent upon the age, sex, idiosyn- 
crasies, and condition of the patient. The amounts given under 
the different preparations are such as experience has shown to be 
safe ordinarily as the initial ones for adults, succeeding doses being 
adjusted according to the indications of the individual case. 

Opium compared with its Alkaloids. 

Morphine does not stimulate the nervous and circulatory sys- 
tems so much as opium, nor is it so decided a narcotic or con- 
vulsant. Morphine is more apt to excite nausea and vomiting, and 
its sequelae are of longer duration. 



NARCOTICS. 467 

Opium slightly increases the temperature — morphine lowers it; 
and, while the former accelerates, the latter retards the pulse. 

The continued use of morphine hypodermically tends to con- 
stipate, while its prolonged action upon the stomach is apt to 
occasion diarrhea : under like circumstances opium does not pro- 
duce diarrhea, its only effect being a cessation of confinement in 
the bowels. Morphine, therefore, ingested, fails to constipate, while 
opium is the better drug to check diarrhea. 

Morphine is excreted more readily than opium, and does not 
affect the secretion of bile. 

Opium possesses greater diaphoretic properties than morphine. 

Morphine produces more irritability of the bladder, frequently 
causing ardor urinae. It also occasions much greater itching of 
the skin, which usually begins and is intense about the eyes and 
nose. In its action as an anodyne and soporific morphine is more 
rapid and certain than opium. 

Codeine is a much feebler anodyne and hypnotic than morphine, 
4 grains (0.25 Gm.) being about equivalent to I grain (0.06 Gm.) 
of the latter drug. It produces sleep, however, freer from disturb- 
ance, with a less disagreeable sequel. 

Codeine has a more marked and selective action than morphine 
upon the nerves of the abdominal viscera. 

It possesses an advantage over both opium and morphine in that 
it can be given in increasing doses without producing narcosis. 

It is more stimulating to the spinal cord and sedative to the 
pneumogastric nerve than morphine. 

Codeine is superior to opium or morphine as a stimulant to the 
glycogenic function of the liver. In the treatment of diabetes mel- 
litus it surpasses all other drugs, almost invariably lessening, and. 
often entirely removing, the sugar from the urine. In justice, how- 
ever, to authorities so eminent as Bruce, Frazer, and Osier it may 
be said that they consider morphine much more reliable than code- 
ine in diabetes, regarding the latter as nothing save a weak or 
diluted morphine. 

Admitting the general correctness of this opinion, codeine is 
nevertheless preferable to morphine or opium in prolonged admin- 
istration, as is necessary in diabetes, at least for the reasons that no 
untoward manifestations accompany its use, and that it does not 
engender an habitual proclivity for the drug. 

Finally, codeine is a valuable remedy in troublesome or nervous 
cough or to quiet the cough in bronchitis and phthisis, and is also 



468 A TEXT-BOOK OF MA TERIA MEDICA. 

efficient in gastrodynia. Codeine should be administered in water, 
syrup, elixir of orange, or in the form of pills or capsules. 

The true action of the following alkaloids is so questionable 
that they are seldom, if ever, prescribed : 

Narceine is alleged by equally competent observers to possess 
feeble hypnotic properties and to be practically inert. 

Narcotine is a misnomer, the preparation being devoid of nar- 
cotic power, although it is said to possess marked stomachic and 
antiperiodic properties. 

Papaverine is a mild hypnotic and cardiac sedative. 

Thebaine is a powerful tetanizing poison, its action upon the 
spinal cord being analogous to that of strychnine and brucine. 

Allied Morphine Compounds. 

Heroine — Di-acetyl Morphine. — This is an acetic ester of morphine. It is a 
white, crystalline powder, of faintly bitter taste, but practically insoluble in water, but 
rendered soluble with dilute acids. It is useful as a substitute for morphine as an anti- 
spasmodic in cough, and is particularly valuable in respiratory difficulties. It is less of 
a cerebral depressant. It can bring about a habit. Dose, y 1 -- ^ grain (0.005-0.1 Gm.). 

Dionine — Mon-acetyl Morphine Hydrochloride. — This is much similar to the 
preceding, a single acetyl rest entering into the combination. It has much the same 
properties, but is deemed more poisonous. Severe poisoning has resulted. Dose, not to 
exceed \ grain (0.012 Gm.). 

Peronine. — This is an analogous compound — the benzyl ester of morphine. It is 
a soluble white powder, and resembles codeine in action, over which it has no advant- 
ages and has some disadvantages. Dose, up to I grain (0.06 Gm.). 



Humulus— Humuli— Hops. U. S. I*. 

Origin. — The strobile-like aments of Humulus lupulus L., a 
rough, climbing perennial, native and cultivated in the north tem- 
perate zone. 

Description and Properties. — Ovate, about i^ inches (3.17 Cm.) 
long, consisting of a thin, hairy, undulating axis and many obliquely 
ovate, membranaceous scales, the upper portion of which is reticu- 
lately veined and the lower parallel-veined, glandular, surrounding 
a subglobular akene ; color of the scales greenish, free from red- 
dish or brownish spots, odor aromatic, and taste bitter, aromatic, 
and slightly astringent. The active and important constituent is — 

Lupullnum— LupuIIni— Lupulin. U. S. JP. 

Origin. — A glandular powder separated from the aments of 
Humulus lupulus. 



NARCOTICS. 469 

Description and Properties. — Bright, brownish-yellow, becom- 
ing yellowish-brown, resinous, consisting of minute granules which 
under the microscope are seen to be subglobular, or, rather, hood- 
shaped, and reticulate — aromatic and bitter. 

Dose of Lupulin. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparations of Hamulus. 

Tinctura Humuli — Tincturae Humuli — Tincture of Hops. — Dose, 1-2 fluid- 
drachms (4.0-8.0 Cc). 

Official Preparations of Lupulin. 

Extractum Lupulini Fluidum— Extracti Lupulini Fluidi — Fluid Extract 
of Lupulin. — Dose, 5-30 minims (0.12-2.0 Cc). 

Oleoreslna Lupulini— Oleoreslnse Lupullni— Oleoresin of Lupulin.— Dose, 
1-5 grains (0.06-0.3 Gm.). 

Unofficial Preparations. 

Infusum Humuli— Infiisi Humuli— Infusion of Hops. — Dose, 1-4 ounces 
(30-125 Cc). 

Tinctura Lupulini — Tincturae Lupulini — Tincture of Lupulin. — Dose, y 2 -2. 
fluidrachms (2-8 Cc). 

Antagonists and Incompatibles. — Mineral acids and metallic 
salts. 

Synergists. — Alcohol; opium, lactucarium, and many other 
narcotics. 

Physiological Action. — Externally and Locally. — Hops are 
sedative and astringent. 

Internally. — Digestive System. — The action of hops is similar to 
that of vegetable bitters, augmenting the secretions from the sali- 
vary and gastric glands, thereby promoting appetite and digestion. 

Circulatory System. — The heart's action is slightly increased, the 
remedy also raising arterial tension and exciting the cutaneous cir- 
culation. 

Nervous System. — Like opium, hops primarily stimulate the 
brain, and secondarily act as a mild soporific. These effects are 
increased if the preparation be an alcoholic one, such as beer. 
The hypnotic action is due partly to the volatile oil which the hops 
contain. 

Respiratory System. — They slightly stimulate the respiration. 

Absorption and Elimination. — The active principles of hops are 
chiefly eliminated by the skin and kidneys, increasing considerably 
the sweat and urine. 



470 A TEXT-BOOK OF MATERIA MEDICA. 

Temperature is unaffected. 

Untoward Action. — None is noticeable, although the drug pos- 
sesses marked aphrodisiac properties. 

Therapeutics. — Externally and Locally. — The sedative action 
of hops is utilized in what are known as hop poultices in superficial 
and abdominal inflammations, in orchitis, and as a preventive of 
chordee. 

A hop pillow is frequently employed to induce sleep and allay 
the pain of earache, while, if the pillow be moistened with weak 
vinegar and the fumes inhaled, the result is found to be efficacious 
in the treatment of inflammatory conditions of the upper respiratory 
passages. 

Internally. — Its stomachic and carminative properties render this 
remedy valuable in atonic dyspepsia, so called, and in flatulent colic \ 
Preparations of hops are also useful in febrile restlessness. 

Priapism, perverted sexual appetite, spermatorrhea, etc. may be 
relieved by lupulin. 

The combined tinctures of lupulin and capsicum serve as ex- 
cellent substitutes for alcoholic stimulants during the treatment 
of alcoholism, as well as being useful remedies in mild attacks of 
delirium tremens. 

Administration. — Lupulin and oleoresin of lupulin are best 
given in pills and capsules respectively. The tincture and fluid 
extract should be administered in syrup. 

Lactucarium— Lactucarii— Lactucarium. U. S. -P. 

Origin. — The concrete milk-juice of Lactuca virosa L., a bien- 
nial rank-smelling herb growing in Europe. 

Description and Properties. — It occurs in sections of plano- 
convex, circular cakes, or in irregular, angular pieces, externally 
grayish-brown or dull reddish-brown, internally whitish or yellow- 
ish, of a waxy lustre, heavy, narcotic odor, and somewhat bitter 
taste. It contains lactucin, lactucopicrin, lactucic acid, lactucerin, 
and wax. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 

Official Preparations. 

Tinctura Lactucarii — Tinctiirse Lactucarii — Tincture of Lactucarium. — 

Dose, \-i fluidrachms (1.0-8.0 Cc). 

S^rupus Lactucarii — Syrupi Lactucarii — Syrup of Lactucarium. — Dose, I- 

4 fluidrachms (4.0-15.0 Cc). 



NARCOTICS. 471 

Synergists. — The same as for opium. 

Physiological Action and Therapeutics. — Its action closely 
resembles that of opium, save that it is very feeble, in adults never 
producing alarming symptoms. It is slightly soporific and anodyne, 
and also diuretic, which properties, especially in the syrup form, 
render it of some value in cases of irritating cough, as well as in 
sleeplessness and nervousness of children. 

Lactucin may be given in doses of from 1 to 5 grains (0.06-0.3 
Gm.) as a mild sedative and hypnotic. 

Cannabis Tndica— Cannabis Tndicae— Indian Can- 
nabis. TJ. S. P. 

(Indian Hemp.) 

Origin. — The flowering tops of the female plant of Can?zabis 
sativa L., grown in the East Indies. 

Description and Properties. — The article of commerce con- 
sists of bundles of a few flowers, the branches and bracts, and 
nearly ripe fruit, the whole more or less agglutinated by a resinous 
exudation. Of a brownish-green color, peculiar, narcotic odor, 
and slightly acrid taste. The drug contains a resin, cannabin, a 
brown, amorphous powder soluble in absolute alcohol, and a vola- 
tile oil. Cannabine and cannabinine are two alkaloids. 

The crude drug is commonly called in India " gunjah." " Bhang," 
" siddhi," or " hashish," the term usually employed — from whose 
toxic effects, frequently inciting to murder, is said to be derived our 
word " assassin " — is another form of cannabis appearing as the 
Arabian confection prepared by mixing aromatics with fruits and 
dried leaves. 

Dose. — 2-5 grains (0.12-0.3 Gm.). 

Official Preparations. 

ExtrSctum Cannabis Indicae — Extr&cti Cannabis Indicae — Extract of In- 
dian Cannabis. — Dose,\-\ grain (0.015-0.06 Gm.). 

Extraxtum Cannabis Indicae Fluidum— Extr^cti Cannabis Indicae Fluidi — 
Fluid Extract of Indian Cannabis. — Dose, 2-5 minims (0.12-0.3 Cc). 

Tinctura Cannabis Indicae (15 per cent.) — Tinctiirae Cannabis Tndicae — 
Tincture of Indian Cannabis. — Dose, 5-20 minims (0.3-1.2 Cc). 

Unofficial Preparations. 

Cannabine Tannate. — Dose, 2-10 grains (0.13-0.60 Gm.). 
Cannabinone. — Dose, \-\ grain (0.03-0.06 Gm.). 



472 A TEXT-BOOK OF MATERIA MEDICA. 

Antagonists and Incompatibles. — Strychnine, caustic alkalies, 
acids, and aqueous preparations are pharmaceutical incompatibles, 
precipitating the resin. 

Synergists. — Alcoholics, ether, bromides, cocaine, and members 
of the present group enhance its cerebral effects. 

Physiological Action. — Externally and Locally. — Its only local 
action is that of a feeble sedative. 

Internally. — Digestive System. — It is slightly sedative to the 
stomach, in many persons appearing to promote the appetite and 
aid digestion. Its use is not followed by constipation or other 
gastro-intestinal disturbance. 

Circulatory System. — A slight acceleration of the pulse is notice- 
able, probably due more to the stimulation of the nervous system 
than to any direct action upon the circulatory apparatus. 

Nervous System. — Like opium, it primarily stimulates the brain, 
large doses producing a peculiar exhilaration and subsequent reac- 
tion more fully described under Poisoning. The period of excita- 
tion is more prolonged than with opium, but is eventually succeeded 
by sleep — almost always disturbed by dreams and spectral illusions. 
The coma resulting from cannabis is never so profound as in the 
case of opium. 

It is like the latter drug as an analgesic, but feebler in its action. 
It is unlike opium in producing a sensation of tingling and numb- 
ness, through its effect upon the sensory nerves, followed by 
cutaneous anesthesia, accompanied by muscular debility and fre- 
quently a cataleptic condition. 

Respiratory System. — No marked or uniform action upon the 
respiration has been observed, it being at times quickened and 
again retarded, though the effects are less pronounced than with 
opium. 

Absorption and Elimination. — Cannabis is slowly eliminated, 
though in what manner is unknown, the effects of the drug some- 
times persisting for twenty-four or thirty-six hours. Of all the 
secretions, the urine alone is affected, the amount being increased. 

Temperature. — Cannabis has no direct depressing action upon 
temperature, which, however, may rise during the period of excita- 
tion and be diminished somewhat during sleep. 

Eye. — The drug differs from opium in that it dilates the pupil 
and produces exaggerated vision. 

Uterus. — It is considered to be a powerful uterine stimulant, and 
like properties are usually ascribed to it as an aphrodisiac, though 



NARCOTICS. 473 

its effect upon sexual desire is not always manifest. It undoubtedly 
increases the energy of the uterus, though possessing no power to 
inaugurate uterine contractions when once suspended. 

Untoward Action. — The uncertain effects of different prepara- 
tions, together with varying susceptibilities to the drug, render it 
almost impossible to cite any characteristic untoward symptoms. 
Certain of the effects described under Poisoning may be present 
even under small doses in persons having an idiosyncrasy against 
the remedy. 

Poisoning. — Large doses of cannabis Indica are wont to produce 
toxic effects which in their manifestations present a singular study 
of psychological phenomena, varying with the temperament and 
idiosyncrasies of the subject, yet in certain characteristics common 
to all who experience the full force of the drug. The transition 
from the influence of medicinal doses to that exerted by poisonous 
absorption is often gradual, many features of the conditions result- 
ing therefrom being strikingly similar. 

Moderate administration, however, is seldom attended by unto- 
ward effects, whereas toxic doses, in place of emotional delight — 
among the earlier sensations — develop an intensity of mental 
anxiety which even contemplates death as the inevitable issue of 
the malady. The buoyancy of spirit, the soothing calm and 
insouciance, the ecstasy of an ethereal mood by which finer natures 
are swayed, — these have given place to a mental and physical 
oppression best described as " a sensation as of the brain boiling 
over and lifting the cranial arch like the lid of a tea-kettle." Not 
infrequently . the blissful nirvana induced by moderate doses is 
rudely broken by an intemperate use of the drug, extreme vio- 
lence and even murderous thoughts supplanting calmer reveries 
and the intellectual solace of passive emotions. Especially is this 
true among Oriental nations — the Hindustanis, for example — 
addicted to excessive indulgence in bhang or hashish, the form of 
the drug generally employed, its effects upon the grosser passions 
rivalling those of opium among the Malays. 

Among the most curious and striking of the psychological 
phenomena attending immoderate doses of hashish is the abolition 
of space and time. So manifold are the images which throng the 
imagination, and so rapid and intense the impressions made upon 
the mind, that the sense of proportion and the normal relations of 
material objects become wholly lost. Thus, the furniture in the 
room may appear infinitely removed to the distorted vision, while 



474 A TEXT-BOOK OF MATERIA MEDICA. 

a few seconds of time may be prolonged by the disordered fancy 
into hours, days, weeks, and even years. These hallucinations, 
strangest of all, are not accompanied by corresponding loss of 
reasoning power, the intellect taking cognizance frequently of the 
true relations of external things, as if aware of its own abnormal 
condition. Nor is volition seriously affected, the mental lesion, so 
to speak, existing rather in lack of coordination between con- 
sciousness and the imaginative faculty. 

These spasmodic or persistent hallucinations are often associated 
with a haunting sense of dual existence, in which all trace of per- 
sonal identity is for the time either obliterated or hopelessly con- 
fused. During a certain stage of poisoning, moreover, the conviction 
of impending death takes possession of the mind ; fear and des- 
peration seize upon the bewildered faculties, intensified by an im- 
pression of physical dissolution ; and the subject endures unspeak- 
able anguish, in which gloomy forebodings of disaster contrast 
terribly with the buoyancy, the temporary joy, and peals of laughter 
accompanying the earlier effects of the drug. 

Upon regaining his normal condition the hashish-eater is either 
wholly oblivious of the events which have transpired during the 
interval of intoxication, or recalls vividly the scenes and incidents 
through which he has passed. As in the case of opium, the pecu- 
liar influence of the drug is largely dependent upon temperament, 
sex, age, and idiosyncrasy. A refined and noble intellect, like De 
Quincey's, might readily be moved to gentler emotions and sensi- 
bilities suffused with human sympathy and love. A baser, more 
unfeeling nature might exhibit latent symptoms of ungovernable 
passion manifested in sensual or criminal conduct scarcely con- 
ceivable either to himself or to others. 

The physiological symptoms characteristic of cannabis-poisoning 
are well marked, the drug acting reflexly yet powerfully upon the 
mental state. Loss of consciousness, followed by collapse or stupor, 
or in some cases resulting in catalepsy and convulsions, in all cases 
complete anesthesia, and in very many a depression of the pre- 
cordium, a sensation of arterial contraction, and cardiac palpitation, 
are among the prominent features of the malady. The sight and 
hearing are perceptibly rendered more acute; the pupils are dilated, 
although contracting to light ; the reflexes are lowered by stimu- 
lation of inhibitory centers ; and an oppressive sense of paralysis 
in the extremities induces horror and despair. The urinary se- 
cretions are augmented, although constipation seldom occurs, 



NARCOTICS. 475 

and a ravenous appetite almost invariably attends the toxic phe- 
nomena. 

Occasionally there is experienced great difficulty in breathing, 
as if the lungs were on the point of bursting. An increase of 
sexual desire is common, although the aphrodisiac properties of 
the drug are not always present. * 

The after-effects of hashish indulgence vary with the physiolog- 
ical and mental peculiarities of the individual. As a rule, they are 
not disagreeable, though it requires time to eradicate the effects of 
the poison. Death directly attributable to the drug has not been 
recorded. 

Treatment of Poisoning. — Among antidotes, lemon-juice, coffee, 
and tobacco have been favorably mentioned. The best treatment 
appears to be similar to that adopted in cases of chloral- and 
opium-poisoning. 

Therapeutics. — Externally and Locally. — Cannabis is very 
seldom used locally, although it is an ingredient of a powder 
recommended by W. H. Beverly for insufflation in hay fever. 

Internally. — Cannabis has been discarded as a remedy in many 
disorders for which it was formerly used. It is, however, still 
employed to a considerable extent as an hypnotic in melancholia and 
mania and for its anodyne and anesthetic action in neuralgia and 
pruritus. 

As a uterine tonic and anodyne it has been found efficient, either 
alone or in combination with other medicines, in subinvolution, 
chronic metritis, dysmenorrhea, menorrhagia, etc. 

Probably there is no remedy superior to cannabis Indica in 
functional impotence, its action in this disorder being aided by com- 
bining it with ergot and nux vomica. 

It is a valuable adjuvant to cough-mixtures intended to relieve 
tickling or irritation of the throat, as well as to quiet the excessive 
cough of bronchitis or phthisis, being superior to opium in this 
respect, since it disturbs the stomach less and does not produce 
constipation. 

It has been used in spasm of the bladder, and in gonorrhea and 
chordee it has been found to be a most valuable remedy. 

In considering the therapeutics of cannabis Indica reference 
should be made to its efficacy in migraine and headaches, particu- 
larly those present at the menopause. Although as a remedy for 
the former disorder cannabis has been largely superseded by the 
adoption of antipyrine and agents of its class, the old use of tine- 



476 A TEXT-BOOK OF MA TERIA MEDICA. 

ture of gelsemium, combined with tincture of cannabis, serves an 
important purpose in aborting the distressing attacks of migraine. 

Administration. — The extract should be given in pill form ; the 
tincture and fluid extract, in an alcoholic menstruum. As has been 
already intimated, different samples vary greatly in strength ; it is 
therefore best to begin with the minimum dose until the force and 
quality of the preparation be ascertained. 

It is advisable to prescribe invariably the preparations of that 
particular manufacture which experience has shown to produce 
samples of uniform strength. 



The following drugs — Belladonna, Stramonium, Hyoscyamus 
— belong to the Solanaceae, and are by some authors classed as 
Mydriatics, on account of their characteristic action on the pupil. 
It has been thought best in the present work to include them in 
the subdivision of Narcotics, because of their narcotic properties, 
utilized clinically in the treatment of diseased conditions. 

Belladonna is considered the type of the Mydriatic Narcotics, 
and claims the first attention. Two portions of the plant are used 
— the leaves and the root. 

Belladonnae Folia— Belladonnae Foliorum— Bella- 
donna Leaves. TJ. S. JP. 

Origin. — The leaves of Atropa Belladonna r L., a nearly glabrous, 
herbaceous, perennial plant, from 4 to 6 feet (1.2-1.8 M.) high, 
bearing dark-purple, bell-shaped flowers and shining purplish- 
black berries of the size of a cherry. It is found in the woods, 
chiefly in the mountainous districts, of Central and Southern Eu- 
rope, and as far east as Asia Minor, Caucasia, and Central Asia. 
It is cultivated in Europe and in the United States to some extent, 
being known by the common name of " deadly nightshade." 

Description and Properties. — The leaves are from 4 to 6 
inches (10-15 Cm.) long and about one-half as broad, broadly 
ovate, equilaterally narrowed into a petiole, tapering at the apex, 
entire on the margin, smooth, thin, the upper surface brownish- 
green, the lower surface grayish-green, both surfaces whitish punc- 
tate ; odor slight, taste bitterish and disagreeable. 

Belladonna leaves contain from 0.2 to 0.6 per cent, of atropine, 
the most important alkaloid, belladonnine (probably anhydro-atro- 



NARCOTICS. 477 

pine), besides an alkaloid identical with hyoscy amine, duboisi?ie, 
daturine, atropamine — sometimes present — and chrysatropic acid 
(scopaline). 

Dose. — 1-5 grains (0.06-0.30 Gm.). 

Official Preparations. 

Extr^ctum Bellad6nnae Foliorum Alcoh61icum — ExtrScti Bellad6nnae Fo- 
liorum Alcoh61ici — Alcoholic Extract of Belladonna Leaves. — Dose, \-\ grain 
(0.008-0.048 Gm.). 

Empiastrum Bellad6nnse (20 percent.) — Empiastrum (ace.) Bellad6nnae — 
Belladonna Plaster. — For external use. 

Formula: Alcoholic Extract of Belladonna Leaves, 200; Resin Plaster, 400 ; Soap 
Plaster, 400. 

Tinctura Belladfinnae Foliorum (15 percent.) — Tinctiirae Bellad6nnae Folio- 
rum — Tincture of Belladonna Leaves. — Dose, 5-20 minims (0.3-1.2 Cc.). 

UnguSntum Bellad6nnse (10 percent.) — Ungu&nti Belladbnnae — Belladonna 
Ointment. — For external use. 

Formula: Alcoholic Extract of Belladonna Leaves, 10; Diluted Alcohol, 5; Ben- 
zoinated Lard, 85. 

Belladonnae Radix— Belladonnae Radicis— Bella- 
donna Root. U. S. r. 

Description and Properties. — The root of Atropa Belladonna 
occurs in cylindrical, somewhat tapering, longitudinally wrinkled 
pieces, \ inch to I inch (12-25 Mm.) thick; externally brownish- 
gray, internally whitish ; fracture nearly smooth and mealy, not 
radiating or showing medullary rays in the thicker roots, except in 
the layer near the bark ; nearly inodorous, of sweetish taste, after- 
ward bitterish and strongly acrid. 

The root contains the same constituents as the leaves, with the 
exception of chrysatropic acid — which is wanting — and in addition 
a red coloring principle, atrosin, found also in the berries. 

Ojjicial Preparations. 

Extr^ctum Bellad6nnae R&dicis Fluidum— Extr^cti Bellad6nnae Radicis 
Fluidi — Fluid Extract of Belladonna Root. — Dose, 1-3 minims (0.06-0.18 Cc). 

LinimSntum Belladdnnae (95 per cent.) — LinimSnti Bellad6nnae — Bella- 
donna Liniment. — For external use. 

Formula: Camphor, 50; Fluid Extract of Belladonna Root, 950. 

The important alkaloid of belladonna is — 

AtropTna— Atroplnae— Atropine. U. S. JP. 

Description and Properties. — White acicular crystals, or a 
more or less amorphous white powder, odorless, having a bitter, 



478 A TEXT-BOOK OF MATERIA MEDIC A. 

acrid taste, gradually assuming a yellowish tint on exposure to air. 
Soluble in 130 parts of water, 3 parts of alcohol, 16 parts of ether, 
4 parts of chloroform, and about 50 parts of glycerin. 
Dose. — 1 | - 4 1 grain (0.0005-0.0016 Gm.). 

Atroplnae Sulphas— Atropinae Sulphatis— Atropine 
Sulphate. U. S. J\ 

Description and Properties. — A white, indistinctly crystalline 
powder, odorless, having a very bitter, nauseating taste, permanent 
in air. Soluble in 0.4 part of water, 6.2 parts of alcohol, 2270 
parts of ether, and 694 parts of chloroform. 

Dose. — T \ q - ^q grain (0.0005-0.0016 Gm.). 

HOMATROPINA — HOMATROPIN^ HOMATROPINE. 

An unofficial and derivative alkaloid, obtained by the action of 
dilute hydrochloric acid on amygdalate of tropin. The hydrobro- 
mate of homatropine is used only as a mydriatic. 

Allied Plants. 

Atropa Mandragora L., Mandrake, closely resembles Atropa Belladonna. It pos- 
sesses marked anesthetic properties, and contains a mydriatic alkaloid. It is especially 
interesting because of its ancient history, its action having been fully described by 
Dioscorides and Pliny. Historians and poets have alike celebrated its peculiar and 
wonderful properties. 

Sc6polia Carni61ica and Scftpolia Japonica both resemble belladonna physic- 
ally, and somewhat in their physiological action, the roots and leaves of these plants 
having been found mixed with those of belladonna. 



Antagonists and Incompatibles. — Muscarine antagonizes the 
action of belladonna in nearly every particular, and physostigmine, 
pilocarpus, and aconite counteract many of its effects. Opium an- 
tagonizes its action on the cerebrum, pupil, heart, respiration, arterial 
tension, and kidneys. 

Atropine is incompatible with caustic alkalies, tannin, and vege- 
table infusions containing tannin, an insoluble tannate of the alka- 
loid being formed. 

Synergists. — The mydriatic drugs mentioned above aid the 
action of belladonna. 

Physiological Action. — The action of belladonna is dependent 
upon the amount of atropine it contains. 

Externally and Locally. — When locally applied atropine is 
anodyne, antispasmodic, resolvent, antisecretory, and mydriatic. 



NARCOTICS. 479 

When thus used, in combination with absorbable substances — 
such as alcohol, camphor, animal fats, glycerin, etc. — it diminishes 
the sensibility of the sensory nerves, and when absorbed from raw 
surfaces of the skin or from the subcutaneous tissue it is capable 
of producing systemic effects. 

Internally. — Digestive System. — Even small doses produce dry- 
ness of the mouth, owing to the greatly diminished secretion of 
saliva and mucus. The salivary secretion is lessened through 
paralysis of the peripheral endings of the chorda tympani nerve 
in the submaxillary gland. 

The drug probably diminishes the secretions from the stomach, 
liver, pancreas, and intestines in a similar manner. It is reasonable 
to suppose that it produces these effects, since it checks all other 
secretions, with the possible exception of the urine. The sweat is 
diminished through paralysis of the peripheral nerve-endings in the 
sudoriparous glands. The secretion of milk is reduced by paral- 
ysis of the peripheral terminations of the secretory nerves in the 
mammary glands. The secretion from the bronchial mucous mem- 
branes is lessened through the depressing influence of the drug 
upon the nerve-endings. 

Brunton claims that the peristaltic movements of the intestines 
are increased by small doses, large doses checking them. 

This he considers due to the action of the drug upon the 
nervous ganglia in the walls of the intestines. It is a well-known 
fact that atropine paralyzes the motor nerve-endings in unstriped 
muscles. This is shown by its action on the vagus endings in the 
heart, which organ it completely paralyzes, stimulation of the 
vagus having no longer any effect. The action of atropine on the 
intestines is easily shown by exposing the intestines of a cat, the 
viscera being immersed in a warm, physiological salt solution. 
Upon the injection of muscarine the peristaltic action is much 
increased ; but upon the injection of even a minute quantity of 
atropine the peristaltic action is at once arrested. It is an estab- 
lished fact that muscarine stimulates the nerve-endings, while the 
same points are paralyzed by atropine. Muscarine has no action 
after atropine ; nor has electric stimulation of the supposed motor 
nerves (vagus) connected with intestines any influence, showing 
conclusively that atropine, even in small doses, does not increase 
peristalsis. 

Circulatory System. — Medicinal doses of atropine or belladonna 
at first retard the pulse, but it is quickly accelerated and rendered 



480 A TEXT-BOOK OF MATERIA MEDICA. 

firmer, with increased arterial pressure. The primary transitory 
action is due to a slight stimulation of the vagi roots, the subse- 
quent quickening of the pulse resulting from paralysis of the 
peripheral ends of the pneumogastric nerve distributed in the car- 
diac muscle. The inhibition being thus removed, the heart re- 
sponds to the influence of the accelerator nerves. The center for 
these nerves in the medulla is also stimulated by the drug, increas- 
ing still further the rapidity of the heart's action. The cardiac 
muscle itself, being stimulated, renders the contractions of the 
heart more forcible. 

Arterial tension is increased not only by the greater rapidity 
and force of the heart, but also by the contraction of the arterioles 
arising from stimulation of the vaso-motor center. Very large or 
poisonous doses lower arterial pressure. This effect is produced 
by exhaustion of the vaso-motor center from over-stimulation, 
resulting in dilatation of the cutaneous arterioles, which lowers 
arterial tension and flushes the skin. Overwhelming doses may 
weaken the cardiac muscle itself from over-stimulation, weakening 
the heart's contractions, as well as paralyzing the terminal nerve- 
filaments in the muscles of the vessel-walls, and even the muscular 
fibers. 

Nervous System. — A full medicinal dose of belladonna stimulates 
the brain, while large doses — and, in susceptible persons, medicinal 
ones — may produce hallucinations and delirium, accompanied by 
spectral illusions. The delirium may be mild, joyful, and talkative, 
or it may assume a violent type. It may, moreover, persist for a 
long time, after which the patient sinks to sleep, induced either by 
exhaustion from the delirium or a secondary depressing action of 
the drug. True coma, like that produced by opium, rarely if ever 
occurs. 

The spinal cord shares in the stimulation caused by belladonna. 
The reflexes are at first slightly exaggerated, being afterward 
diminished. Very often under poisonous doses there is complete 
motor paralysis, the loss of power occurring first in the lower 
extremities. 

The sensory nerves are depressed, especially when the drug is 
locally applied, the influence being exerted on their terminal fila- 
ments. For this reason belladonna is of little service as an ano- 
dyne when given internally. 

Respiratory System. — Medicinal doses quicken and deepen the 
respirations, owing to stimulation of the respiratory center. The 



NARCOTICS. 481 

peripheral nerve-filaments of the pulmonary vagi are, however, 
depressed ; which, were it not for the increased action of the center, 
would retard respiration. 

Poisonous doses over-stimulate, and consequently exhaust or 
paralyze, the respiratory center, the result being slow and shallow 
breathing or perhaps death from asphyxia. 

Absorption and Elimination. — Atropine is rapidly absorbed and 
eliminated, chiefly by the kidneys, but also to some extent by the 
bowels. It is said that part of the drug is destroyed by the liver. 

Temperature. — Large doses slightly increase bodily heat, proba- 
bly by increasing the circulation and respiration, consequently aug- 
menting combustion. Some authors maintain that belladonna 
stimulates the heat-center. In cases of severe poisoning from the 
drug the temperature rapidly falls. 

Eye. — Belladonna dilates the pupil, whether locally applied or 
taken internally, its effect differing from that of cannabis Indica in 
that the pupil cannot be made to contract by stimulation of the 
third nerve, although excitement of the muscle itself causes pupil- 
lary contraction. The manner in which atropine dilates the pupil 
is not yet satisfactorily explained, the prevailing opinion being in 
favor of Jessup's theory that the action is due to a stimulation of 
the ends of the sympathetic nerve-filaments distributed to the iris, 
and paralysis of the peripheral ends of the oculo-motor nerves. 

Atropine increases intraocular tension, rendering it a dangerous 
drug in glaucomatous conditions. 

Untoward Action. — Very frequently there appears, especially in 
children, an erythematous or scarlatinal eruption, oftener noticeable 
on the face and neck, but sometimes affecting the entire surface of 
the body. Redness and pain in the throat may also be present, but 
no fever, with itching of the skin or desquamation. 

Occasionally instillation of atropine into the eye produces pro- 
fuse lacrymation, edema of the eyelids, and blepharo-conjunctival 
irritation. 

When taken internally in medicinal doses it sometimes occasions 
in certain persons vertigo, turgescence of the face, hallucinations, 
erethistic debility, and impaired assimilation. 

Homatropine has caused dizziness, uncertainty of gait, fatigue, 
difficulty in deglutition, and loquacious delirium. 

Poisoning. — The poisonous actions of belladonna may be sum- 
marized as follows : 

The skin is dry and hot; the conjunctivae are congested, with, 

31 



482 A TEXT-BOOK OF MATERIA MEDICA. 

possibly, edema of the eyelids and pupils widely dilated ; the face 
is swollen, while the whole body may be covered with an erythem- 
atous rash, and there is a sensation of heat and pain in the throat 
and difficulty in swallowing. 

Rapid respirations, muscular weakness, and incoordination of 
movements appear ; the patient becomes dizzy or mildly or violently 
delirious, continually talking, shouting, or laughing. While there 
is a constant desire to micturate, there is an inability to pass 
any urine. At this stage the respirations are slow and shallow. 
Finally, convulsions may occur, and the patient sink into a coma- 
tose condition and die from asphyxia and cardiac exhaustion. 

Treatment of Poisoning. — Wash out the stomach with solutions 
of tannic acid, pursuing the treatment with the cautious adminis- 
tration of physostigmine, opium, or the hypodermic injection of 
pilocarpine. Should cardiac failure be pronounced or the patient 
lapse into a state of stupor, stimulants and the subcutaneous injec- 
tion of caffeine are indicated, the patient being aroused meanwhile 
and kept awake if possible, respiration being maintained by the use 
of strychnine and by artificial means when necessary. Should the 
temperature fall below normal, external heat must be applied. 

Atropine compared with Morphine. 

Atropine stimulates respiration ; morphine is a powerful respi- 
ratory depressant. Atropine dilates the pupil ; morphine contracts 
it. Atropine increases bodily heat, and frequently reddens the 
surface of the skin; morphine produces pallor of the skin and 
lowers temperature. 

Both drugs lessen peristaltic action of the bowels. Atropine 
-reinforces the functional activity of the kidneys ; morphine lessens 
it. On the other hand, atropine checks the secretion from the 
:skin, while morphine increases it. 

The remaining secretions are diminished by both drugs, but in 
different ways. Atropine, for instance, checks secretion by depress- 
ing the peripheral terminations of the secretory nerves ; morphine, 
by depressing the secretory center in the medulla. 

Both drugs depress the sensory mechanism, yet again by differ- 
ent actions, atropine depressing the function of the sensory nerve- 
terminations, and morphine depressing the center mainly, although 
to some extent influencing the entire sensory tract. 

Atropine acts rather as a cerebral excitant, producing delirium, 
hallucinations, and disturbed sleep ; morphine is more of a cerebral 



NARCOTICS. 483 

depressant, the period of mental excitation being comparatively- 
brief, while sleep is longer and more profound. 

In medicinal doses atropine contracts the arterioles ; morphine 
dilates them. Again, while morphine, like atropine, causes the 
heart to beat faster and stronger, it is by no means so powerful a 
cardiac stimulant as atropine. 

In many respects these drugs are mutually synergistic. Both 
relieve pain, though morphine is much the more powerful anodyne. 
Both cause incoordination of muscular movements and mental 
confusion. 

Although in many respects antagonistic, they are frequently 
combined when an anodyne action is desired. As has been forcibly 
suggested, their reciprocal influence, when administered together, 
modifies in a remarkable manner their physiological effects. 

Therapeutics. — The many uses for which belladonna has 
been employed would render it a difficult, perhaps useless, task 
to enumerate them. As in the case of opium, there are cer- 
tain general and important actions in disease which the physician 
can utilize in daily practice, a succinct mention of which is ap- 
pended : 

1. Belladonna is serviceable in relaxing spasms of invol- 
untary muscles, as in asthma, spasmodic colic, lead colic, spasmodic 
dysmenorrhea, laryngismus stridulus, etc. 

2. In diminishing secretion, as in acute coryza, bronchitis, night- 
sweats of phthisis, and to check the secretion of milk, mercurial 
ptyalism, etc. 

3. In relieving pain, either combined with opium or morphine, 
or alone, particularly where it can be applied locally, as in lumbago, 
neuralgia, pleurodynia, etc. 

4. Belladonna is used to stimulate the circulatory system 
in cases of a weak heart and low arterial tension, as in fevers, etc. 

5. For its peculiar action upon the eye in ophthalmo- 
logical practice, to dilate the pupil, prevent adhesion, remove 
congestion, relieve pain, and afford rest. 

While, as has been said, it is impossible to mention in detail the 
manifold uses of belladonna, its more important therapeutic services 
may be here mentioned : 

Externally and Locally. — Belladonna ointment is useful in the 
treatment of boils, carbtmcles, chronic inflammatory conditions about 
the articulations, chronic synovitis of the knee-joi?it, its efficiency in 
the latter condition being enhanced by combining it with mercurial 



484 A TEXT-BOOK OF MA TERIA MEDICA. 

ointment. Orchitis is greatly relieved by covering the testicle with 
belladonna ointment. Suppositories containing extract of bella- 
donna are beneficial in the treatment of hemorrhoids and in anal 
fissure. A rigid os may be made to dilate, hastening delivery, by 
smearing the cervix with the ointment of this drug. 

Eczema and excessive sweating of certain areas of the skin, such 
as the palms and soles, are benefited by a local application of the 
tincture or the dried and powdered extract mixed with some inert 
desiccant powder like powdered talcum. 

Belladonna plaster is one of the most useful applications in cases 
of acute or chronic muscular rheumatism, and in certain forms of 
neuralgia. In its power to arrest the secretion of milk the drug 
is perhaps without an equal. Should inflammation have already 
set in and the breasts be swollen and painful, the ointment is to be 
applied and the breasts covered with hot flaxseed poultices, the 
parts being entirely supported by wide bandages. 

Internally. — Belladonna is combined with opium to relieve the 
pain of gastralgia and enteralgia, while its combination with strych- 
nine and iron is useful in anemic neuralgia. 

Next to bromoform, it is the most efficient remedy in whooping 
cough; the spasmodic manifestations of hysteria are also favorably 
affected by full doses of tincture of belladonna. 

Nocturnal incontinence of urine in children, when resulting from 
supersensitiveness of the mucous membrane of the bladder, derives 
signal benefit from this drug. By depressing the ends of the sen- 
sory nerves distributed to the bladder belladonna prevents the irri- 
tation of the accumulated urine from being conveyed to the center 
in the cord, and from there reflexly exciting the detrusor muscle 
of the sphincter and causing micturition. 

Belladonna combined with strychnine stimulates the respiration 
and checks the sweating in phthisis. A similar union with some 
laxative drug makes an exceedingly useful pill in habitual constipa- 
tion, while the obstinate constipation due to lead-poisoning is greatly 
relieved by belladonna. 

This drug, as well as the other mydriatic narcotics, is one of the 
most reliable remedies we possess to relieve the symptoms of spas- 
modic asthma. It is highly recommended also by many physicians 
in typhoid fever to support the circulation and relieve many dis- 
tressing symptoms of the disease. In scarlatina, too, it is thought 
to be a useful remedy. 

Cardiac pain and distress due to over-action of the heart are 



NARCOTICS. 485 

alleviated by the application of belladonna plaster over the cardiac 
region or by the internal use of the drug. 

Intestinal, hepatic, and renal colic, cystitis, prostatitis, spermator- 
rhea, exoplithalmic goiter, cerebral and spinal hyperemia, sea-sickness, 
facial erysipelas, and menorrhagia have all apparently been favor- 
ably influenced by belladonna. 

Atropine subcutaneously injected is a powerful antidote to chlo- 
roform-, physostigma-, aconite-, and jaborandi-poisoning, as well as 
that contracted from poisonous mushrooms. 

Administration. — The crude drug, leaves, and root are seldom 
if ever used. Owing to its action in diminishing secretion, it is 
better to time the internal administration of belladonna so as to 
interfere as little as possible with the process of digestion. 

Children are peculiarly insusceptible to this drug, sometimes 
tolerating as large doses as adults. 

When atropine is used hypodermically in cases of sciatica or 
neuralgia, the injection should be made deeply in close proximity 
to the affected nerve-trunk. 

The part of the body to which a belladonna plaster is to be 
applied should be first thoroughly cleansed and dried, the exact 
area to be covered being specifically designated by the physician. 
Caution should be exercised in the application, lest too large a 
space be covered by the plaster and dangerous symptoms super- 
vene from absorption of its more active constituents, a result which 
may also occur from too prolonged contact, from three to five days 
being usually sufficient. Should it be desirable to continue the 
influence of the drug, the application of fresh plaster from time to 
time will produce better results than too long use of a single one. 

Stramonii Folia— Stramonii Foliorum— Stramonium 
Leaves. U. S. JP. 

(Thorn-apple; Jamestown or Jimson Weed.) 

Origin. — The leaves of Datura Stramonium L., a coarse-look- 
ing annual weed, believed to be a native of Asia, but found grow- 
ing in waste places and along roadsides throughout the greater 
part of the world. 

Description and Properties. — From 3 to 8 inches (7-20 Cm.) 
long, petiolate, dark-green, smooth, ovate, pointed, unequal, espe- 
cially at the base, coarsely and sinuately toothed ; thin, brittle and 
nearly inodorous ; taste unpleasant, bitter and nauseous. Stramo- 



486 A TEXT-BOOK OF MA TERIA MEDICA. 

nium leaves contain about 0.2 per cent, of a mixture of atropine 
and hyoscamine known as daturine. 
Dose. — 1-5 grains (0.06-0.3 Gm.). 

Stramonii Semen— Stramonii Seminis— Stramo- 
nium Seed. TJ.S.l?. 

Origin. — The seed of Datura Stramonium L. 

Description and Properties. — About \ inch (4 Mm.) long, 
reniform, flattened, pitted and wrinkled, testa dull brownish-black, 
hard, enclosing a cylindrical, curved embryo imbedded in a whitish, 
oily perisperm ; of an unpleasant odor when bruised, and of an 
oily and bitter taste. 

The seeds contain a larger proportion of daturine than the 
leaves, besides scopalimine, resin, fixed oil, etc. 

Dose. — 1-3 grains (0.06-0.2 Gm.). 

Official Preparations. 

Extractum Stramonii SSminis — Extr^cti Stramonii SSminis — Extract of 
Stramonium Seed. — Dose, \-% grain (0.02-0.03 Gm.). 

Extractum Stramonii SSminis Fluidum — Extracti Stramonii Seminis 
Fluidi — Fluid Extract of Stramonium Seed. — Dose, 1-3 minims (0.06-0.2 Cc). 

Tinctura Stramonii SSminis — Tincturae Stramonii SSminis — Tincture of 
Stramonium Seed (15 per cent.). — Dose, 5-10 minims (0.3-0.6 Cc.). 

Unguentum Stramonii — Ungu&nti Stramonii — Stramonium Ointment (10 
per cent, of extract). — For external use. 

Antagonists and Incompatibles and Synergists are the same 
as for belladonna. 

Physiological Action. — The action of stramonium is almost 
identical with that of belladonna, the main difference being the 
influence of stramonium upon the sympathetic system, the motor 
and sensory nerves being less powerfully affected than by bella- 
donna. Stramonium is more apt to occasion irregular action of 
the heart, and the involuntary muscle-fibers of the bronchial tubes 
are relaxed more by stramonium than by belladonna. It usually 
occasions more delirium and is more of an aphrodisiac than bella- 
donna. 

Poisoning and Treatment of Poisoning are precisely the same as 
described under Belladonna. 

Therapeutics. — The medical uses of belladonna are applicable 
to this drug, although stramonium is much the better remedy in 
spasmodic asthma. The stramonium ointment appears to be 



NARCOTICS. 487 

superior to that prepared from belladonna as an application to 
painful hemorrhoids. 

Administration. — No special directions are necessary, any of 
the preparations being serviceable. For asthma the leaves may be 
smoked in a pipe or in the form of cigarettes, this method of em- 
ploying the drug to relieve bronchial spasm being probably superior 
to internal administration. 



Hyoscyamus— Hyoscyami— Hyoscyamus. U. S. JP. 

(Henbane.) 

Origin. — The leaves and flowering tops of Hyoscyamus niger L., 
collected from plants of the second year's growth. Henbane is a 
biennial growing in sandy soil and waste places throughout the 
greater portion of Europe and Asia, and naturalized in North 
America. 

Description and Properties. — Leaves ovate or obovate-oblong, 
up to 10 inches (25 Cm.) long and 4 inches (10 Cm.) broad; sinu- 
ate-toothed, the teeth large, oblong, or triangular; grayish-green, 
and, particularly on the lower surface, glandular-hairy ; midrib 
prominent ; flowers nearly sessile, with an urn-shaped, five-toothed 
calyx and a light-yellow, purple-veined corolla ; odor heavy, nar- 
cotic ; taste bitter and somewhat acrid. 

The active constituents are hyoscyami7te and hyoscine, and a very 
poisonous volatile oil is obtained by distillation of the leaves, which 
contain also a small percentage of potassium nitrate. 

Dose of the Leaves. — 5-15 grains (0.3-1.0 Gm.). 

Official Preparations. 

Extr3ctum Hyoscyami — Extr^cti Hyoscyami— Extract of Hyoscyamus. — 

Dose, 1-3 grains (0.06-0.2 Gm.). 

Extractum Hyoscyami Fluidum— Extracti Hyoscyami Fluidi — Fluid Ex- 
tract of Hyoscyamus. — Dose, 5-15 minims (0.3-1.0 Cc). 

Tinctura Hyoscyami — Tinctiirae Hyoscyami — Tincture of Hyoscyamus 

(15 per cent.). — Dose, 10-60 minims (0.6-4.0 Cc). 

HyoscTnae Hydrobromas— Hyosclnae Hydrobro- 
matis— Hyoscine Hydrobromate. TJ. S. P. 

Origin. — The hydrobromate of an alkaloid obtained from Hy- 
oscyamus. 

Description and Properties. — Colorless, transparent, rhombic 
crystals, odorless, and having an acrid, slightly bitter taste ; perma- 



488 A TEXT-BOOK OF MATERIA MEDICA. 

nent in the air. Soluble in 1.9 parts of water and in 13 parts of 
alcohol. It should be kept in small, well-stoppered vials. 
Dose. — r^ir~A" g ram (0.0006-0.001 Gm.). 

Hyoscyamlnae Hydrobromas— Hyoscyamlnae Hy- 
drobromatis — Hyoscyamine Hydrobromate. 
U. S. JP. 

Origin. — The hydrobromate of an alkaloid obtained from Hy- 
oscyamus. 

Description and Properties. — A yellowish-white, amorphous, 
resin-like mass or prismatic crystals, having, particularly when 
damp, a tobacco-like odor and an acrid, nauseous, and bitter taste. 
Deliquescent on exposure to the air; soluble in about 0.3 part of 
water and 2 parts of alcohol. It should be kept in small, well- 
stoppered vials. 

Dose. — 3~jJo~4V S ram (0.0006-0.0015 Gm.). 

Hyoscyamlnae Sulphas— Hyoscyamlnae Sulphatis 
—Hyoscyamine Sulphate. U. S. P. 

Origin. — The neutral sulphate of an alkaloid obtained from 
Hyoscyamus. 

Description and Properties. — White, indistinct crystals or a 
white powder, without odor, and of a bitter, acrid taste ; deliques- 
cent in damp air. Soluble in 0.5 part of water and 2.5 parts of 
alcohol. It should be kept in small, well-stoppered bottles. 

Dose. — ± l - ^ grain (0.0006-0.0015 Gm.). 



Antagonists, Incompatibles, and Synergists the same as for 
belladonna. 

Physiological Action. — The action of hyoscyamus is analo- 
gous to that of belladonna, with the following differences : 

1. Hyoscyamus does not depress the peristaltic action of the 
intestines as much as belladonna, but is more efficient in relieving 
the griping and pain occasioned by the rougher cathartics. 

2. It is less powerful than belladonna as a cardiac stimulant, 
though stronger than stramonium. 

3. It does not occasion nearly so much mental excitement as 
belladonna, on account of the hyoscine it contains, which is a 
powerful hypnotic and cerebral and spinal sedative. 



MOTOR EXCITANTS. 489 

4. As a urinary sedative hyoscyamus is greatly superior to 
belladonna. 

5. It differs from belladonna in affecting the respiration less 
powerfully. 

Untoward Action, Poisoning, and Treatment of Poisofiing are the 
same as for belladonna. 

Therapeutics. — Hyoscyamus may be used for the same pur- 
poses as belladonna, but is considered superior to the latter drug 
as a urinary sedative in the treatment of incontinence of urine, 
vesical tenesmus, cystitis, prostatitis, etc. 

For the relief of colic of various forms, and to allay the griping 
produced by certain purgatives, hyoscyamus is better than bella- 
donna. 

In mental and convulsive diseases, such as delusional insanity, 
delirium tremens, acute and febrile mania, insomnia, chronic dementia, 
hysterical convulsions, chorea, paralysis agitans, etc., hyoscyamus, 
particularly hyoscine, is superior to belladonna. 

Hyoscyamus and its alkaloids are fully equal to belladonna in 
the treatment of asthma, whooping cough, neuralgia, enteralgia, etc. 

As an anodyne and hypnotic for children hyoscyamus is safer 
than, and frequently as efficient as, opium. 

Contraindications. — The same as for belladonna. 

Administration. — Like belladonna, this drug should be admin- 
istered tentatively. Any of the preparations may be given. The 
salts of the alkaloids may be administered either subcutaneously 
or internally. 

The hyoscine is tasteless, and may be easily given in various 
drinks. When used internally its action is slower, but more pro- 
longed, than when given hypodermically, though the dose under 
the former method should be twice that of the latter. 



GROUP VI.— MOTOR EXCITANTS. 

The drugs belonging to this group excite the functional activity 
of the spinal cord and the sympathetic nervous system. They 
serve to stimulate muscular contraction and the functional opera- 
tions of the heart, lungs, and secretory apparatus. 

It is difficult to separate by sharply-defined limits the remedies 
having these actions, and group them according to their analogous 
therapeutic uses. 



49° A TEXT-BOOK OF MA TERIA MEDICA. 

In the present group, for instance, are placed ergot and gossyp- 
ium, chiefly used for their action upon the uterus, while those 
drugs which, although excito-motors, are employed principally for 
their action upon the circulatory system are placed in the group, 
Cardiac Stimulants. 

The motor excitants are exceedingly valuable remedies, the 
typical member of the group being Nux Vomica, and therefore 
first considered. 

Nux Vomica— Nucis Vomicae— Nux Vomica. 

XI. S. P. 

Origin. — The seeds of Strychnos Nux Vomica L., a small tree 
common in many parts of Hindustan, Farther India, some of the 
East Indies, and in some parts of Australia. 

Description and Properties. — Nux vomica is about I inch 
(25 Mm.) in diameter, orbicular, grayish or greenish-gray; soft- 
hairy, of a silky luster, with a slight ridge extending from the 
center of one side to the edge ; internally horny, somewhat trans- 
lucent, very tough, with a large circular cavity, into which the 
heart-shaped, nerved cotyledons project. It is inodorous and per- 
sistently bitter. 

Nux vomica contains two important alkaloids — strychnine and 
brucine, the former being in excess. The seeds also contain iga- 
suric acid, with which these alkaloids are combined. Of total 
alkaloids the drug should contain from 2.5 to 5 per cent. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Official Preparations. 

Extr&ctum Nucis VSmicae — Extracti Nucis Vomicae— Extract of Nux 
Vomica. — Dose, |— i grain (0.008-0.03 Gm.). 

Extr&ctum Nucis V6micae Fluidum — Extracti Nucis V6micse Fluidi — 
Fluid Extract of Nux Vomica. — Dose, 1-5 minims (0.06-0.3 Cc). 

Tinctura Nucis VSmicae — Tincturae Nucis V6micae — Tincture of Nux 
Vomica. — Dose, 5-20 minims (0.3-1.2 Cc). 

Strychnlna— Strychnlnae— Strychnine. XT. S. JP. 

Origin. — An alkaloid obtained from Nux Vomica, and also 
derived from other plants of the natural order Loganiacece. 

Description and Properties. — Colorless, transparent, octahedral 
or prismatic crystals, or a white, crystalline powder, odorless and 
having an intensely bitter taste, perceptible even in highly dilute 
(1 to 700,000) solution. Permanent in the air. Soluble at 15 C. 



MOTOR EXCITANTS. 491 

(59 F.) in 6700 parts of water, in no parts of alcohol, in 2500 
parts of boiling water, and in 12 parts of boiling alcohol; also 
soluble in 7 parts of chloroform, but almost insoluble in ether. 

Dose. — -gVrV grain (0.001-0.004 Gm.). 

Strychnine enters into the following preparations : 

FSrri et Strychninae Citras. 

Syrupus FSrri, Quininse et Strychninae Phosphatum. (See Ferrum, page 
198.) 

Strychninae Sulphas— Strychninae Sulphatis— 
Strychnine Sulphate. TI. S. JP. 

Description and Properties. — Colorless or white, prismatic 
crystals, odorless, and having an intensely bitter taste, perceptible 
even in highly dilute (1 in 700,000) solution. Efflorescent in dry 
air. Soluble at 15 C. (59 F.) in 50 parts of water and in 109 
parts of alcohol ; also soluble in 2 parts of boiling water and 8.5 
parts of boiling alcohol. Almost insoluble in ether. 

Dose. — (tt~T6 grain (0.00 1-0.004 Gm.). 

Antagonists and Incompatibles. — Chloral, tobacco, potassium 
bromide, chloroform, and ether antagonize the toxic action of 
strychnine, the first-named drug being the best antagonist. Phy- 
sostigma, curare, conium, opium, hydrastine, and oil of chamomile 
are also antagonistic. 

The incompatibles are tannic acid, bromides, iodides, and chlo- 
rides. 

Synergists. —The motor excitants, ergot, ustilago, electricity, 
and cold. 

Physiological Action. — Since strychnine fully represents the 
physiological action of nux vomica, that of the former is here 
given. 

Externally and Locally. — In large doses strychnine acts as an 
antiseptic, but on account of its poisonous nature it is too 
dangerous to be serviceable. When applied locally to unicel- 
lular organisms, in very dilute solutions, the drug acts as a 
stimulant, increasing their movements. In slightly more con- 
centrated solutions strychnine arrests these movements and de- 
stroys life. 

Internally. — Digestive System. — Strychnine is an excellent sto- 
machic tonic, improving the appetite greatly and aiding diges- 
tion. By its favorable action upon the mucous membrane of 
the stomach it facilitates the secretion of gastric juice, and by 



492 



A TEXT-BOOK OF MATERIA MEDICA. 



imparting tone to the muscular walls of the intestines it increases 
peristalsis and allays constipation when due to lack of muscular 
tone. 

Probably the favorable action which strychnine exerts on the 
stomach is due to its stimulation of the nerve centers which preside 
over the blood-supply and the secretory cells, thus rendering the 
digestive process more perfect. 

Circulatory System. — Strychnine stimulates the heart by its 
action on the cardiac muscle. Pharmacologically the pulse should 

A 




D 



A 
E 




Fig. 5. — Diagram showing how strychnine affects the motor and reflex mechanisms: A, motor 
and sensory mechanisms ; B, cerebral motor areas ; C, sensory center ; D, motor tract ; E, sensory 
tract; F, spinal motor areas ; G, switch center, or mechanism for conveying impressions from sensory 
to motor nerves ; H, sensory nerve ; /, motor nerve ; K, muscle. 



be decreased, owing to the stimulating action of the vagus center 
in the medulla. But this depressing influence seems to be over- 
come by the direct stimulating action upon the heart muscle. In 
therapeutic doses it is generally held that the pulse is slightly 
increased. In poisonous doses the pulse is slowed and weakened, 
owing to over-stimulation of both the heart muscle and the motor 
mechanism. 

Nervous System. — Strychnine enormously increases the excita- 



MOTOR EXCITANTS. 493 

bility of the central nervous axis. The first symptoms of the drug- 
are an increase in all the reflexes. This has been shown by Hol- 
ton and Muirhead to be due to a diminished resistance between 
the cells in the anterior and posterior horns of the cord. Nor- 
mally, stimulation of a certain part — as, for instance, of a frog's 
toe — simply occasions a movement of the part stimulated, no 
other point being affected. But under the influence of strychnine 
the slightest stimulation is often sufficient to throw the whole 
body into tetanic contraction, showing that not only is the resist- 
ance in the normal path followed by lessened reflexes, but that 
resistance in all directions is diminished to such an extent that 
the impulse affects the entire muscular system. This action on the 
reflexes is principally on the cord. In fact, the action of strych- 
nine upon the cord seems to be more powerful than upon any 
other portion of the central nervous axis. That the upper brain 
centers also are stimulated is shown by the fact that all men- 
tal processes are rendered more acute ; and the same is true of 
special senses. Very large doses of strychnine cause paralysis 
of the motor apparatus, with loss of voluntary movement — due 
to over-stimulation of the reflex centers in the cord, producing 
exhaustion. 

It must be remembered that strychnine does not increase the 
automatic powers, but simply augments their susceptibility to 
external stimulation. 

Strychnine greatly intensifies reflex excitability, so that in 
strychnine-poisoning a bright light, a sound, a jar of the bed, or 
touching the skin may reflexly produce a convulsive seizure. 

Respiratory System. — By the stimulating effect of strychnine 
upon the respiratory center in the medulla the breathing is ren- 
dered quicker and deeper. Owing to the tetanic contractions of 
the respiratory muscles, under poisonous doses the breathing is 
greatly interrupted, and the patient may become asphyxiated. At 
length, the respiratory muscles becoming completely exhausted, 
death ensues, although the principal cause of collapse is paralysis 
of the respiratory centre. It is to be noted that the heart con- 
tinues to beat for some time after respiration has ceased. 

Absorption and Elimination. — Strychnine is rapidly absorbed 
and slowly excreted, and consequently accumulates in the system. 
It is eliminated mainly by the kidneys, appearing in the urine as 
strychnine, and is also slightly excreted by the skin and the salivary 
glands. 



494 A TEXT-BOOK OF MA TERIA MEDICA. 

Temperature. — Under therapeutic doses the temperature is 
slightly raised, owing to increased oxidation, as shown by the 
increase of urea and carbon dioxide eliminated and of oxygen 
taken in. During the tetanic convulsions the body temperature 
is markedly raised, though it is generally greatly reduced during 
the stage of exhaustion immediately preceding death. 

Eye. — The general nervous stimulation produced by strychnine 
affects the mechanism of the eye, vision, as has been remarked, 
being rendered more acute. 

Uterus. — Strychnine exerts some influence upon the muscular 
uterine tissues and assists the catamenia. 

Untoward Action. — Certain peculiar manifestations, having but 
slight resemblance, or none whatever, to the characteristic symp- 
toms of poisoning, have followed the ingestion of small doses of 
strychnine. Some observers have noted the presence of a scarla- 
tiniform eruption ; cramps followed by perspiration, resembling in 
some respects the tertian type of intermittent fever ; redness of the 
eyes ; formication ; a peculiar heaviness and stiffness of the limbs ; 
persistent and painful priapism ; and gastric uneasiness. 

Children are exceedingly susceptible to the untoward effects 
of strychnine, its administration requiring extreme caution. The 
author, however, is familiar with a case resulting beneficially in 
the practice of Dr. Alfred C. Cotton of Chicago, when -^ grain 
(0.036 Gm.) of strychnine sulphate was given hypodermically every 
three hours to a child three years of age seriously ill with pneu- 
monia. Such heroic dosage is nevertheless seldom advisable. 

Poisoning. — As is the case with other active poisons, strychnine 
in lethal doses produces varying effects dependent upon tempera- 
ment, idiosyncrasy, and physiological conditions. Generally speak- 
ing, the absorption of large doses is followed by rigidity of the 
lower maxillary, dilatation of the pupils, increased action of the 
reflexes, and spasmodic and distressing muscular contraction, affect- 
ing the extensors particularly. Finally, the respiratory muscles 
are affected with tetanic rigidity, death resulting from asphyxia. 
In many cases the earliest symptoms of poisoning are restlessness 
and anxiety, twitching of the muscles, and stiffness of the neck. 
Spinal convulsions are manifested, the patient assuming the position 
of opisthotonos, so that he rests upon his head and his heels. 

The slightest external irritation at this stage, even a movement 
of the bed-clothes, is sufficient to cause a recurrence of convulsions. 
Notwithstanding these grave symptoms, the mind remains unaf- 



PLATE I 





Strychnine-poisoning. 



MOTOR EXCITANTS. 495 

fected until carbonic-acid poisoning sets in, and the stomach is 
usually retentive. Accompanying the usual symptoms in cases 
of acute poisoning is the distortion of the features, which assume 
a ghastly grin (risus sardonicus). The action upon the genito- 
urinary tract is quite marked, involuntary ejaculations of semen 
frequently taking place, together with incontinence of urine. 

The earlier paroxysms attendant upon the effects of the drug 
are seldom fatal, but in the intervals of repose the patient's mind 
is oppressed with a sense of impending dissolution, intensified by 
each renewed access of spasm and increasing severity of pain. 

Treatment of Poisoning. — Emetics and cleansing of the stomach 
are naturally of the first importance. Animal charcoal and tannic 
acid should be freely administered, while copious anal injections 
containing potassium bromide and chloral are often efficacious in 
relieving the spasms. 

Amyl-nitrite inhalations may prove serviceable as an aid to 
restore failing respiration when artificial means are required. 

The chemical antidote to strychnine is tannin, which should be 
given immediately in the form of an aqueous solution, the stomach 
being subsequently well cleansed. Catheterism should be per- 
formed frequently to favor elimination, care being taken not to 
create a recurrence of spasm and consequent convulsions, which 
may often be obviated by the inhalation of chloroform or ether in 
sufficient quantities to produce complete anesthesia. The bowels 
should be evacuated, croton oil per rectum being an efficient 
agent. 

As has been stated, potassium bromide, chloral, and physostig- 
mine are serviceable physiological antidotes. Opium and conium 
may also be used to counteract the effects of the drug. Paralde- 
hyde has been preferred to chloral, and tobacco and alcohol have 
been suggested, even in heroic doses, should the malady refuse to 
yield to other remedial agents. 

Therapeutics. — Externally and Locally. — M. Mackenzie has rec- 
ommended strychnine in / 4 fa grain (0.0027-0.004 Gm.) doses in 
some harmless and inert medium as an insufflation in anosmia, 
and lint saturated with the tincture of nux vomica and applied to 
the perineum has been advised in incontinence of urine. 

Internally. — There is no more efficient remedy in atonic dys- 
pepsia than nux vomica or strychnine. Both possess all the prop- 
erties of the simple bitters, besides stimulating the nerve-centers, 
rendering the co-ordination of the digestive process more perfect 



496 A TEXT-BOOK OF MATERIA MEDICA. 

and enabling the stomach to respond more readily when the stim- 
ulus of food is applied to it. 

The gastric catarrh of inebriates is especially benefited by this 
drug, which also serves a useful purpose in the vomiting of preg- 
nancy and of phthisis. 

Its tonic action upon the intestinal muscles renders it an invalu- 
able remedy in habitual constipation, atonic diarrhea, and prolapsus 
of the rectum, the latter condition being frequently observed in 
children and aged persons, especially the latter, who are often men- 
tally depressed by this infirmity, and who are relieved by strych- 
nine, either given internally or injected as a solution into the sub- 
cutaneous tissue of the rectum, toning up the muscles and at the 
same time stimulating the cerebrum, relieving the melancholia and 
inspiring the patient with hope. 

Strychnine is a most valuable cardiac tonic, having a marked 
action on the cardiac nervous system and also upon the heart 
muscle. In pneumonia, typhoid fever, and other diseases accom- 
panied by dyspnea and feeble heart-action, no more valuable drug 
can be employed. It differs from alcohol and other cardiac stimu- 
lants in that its use is not followed by depression. The hypoder- 
mic injection of full doses of strychnine ordinarily renders the 
pulse full and strong, even when it is scarcely perceptible and 
death appears imminent. Many clinicians have undoubtedly tided 
pneumonic patients over the critical period by the heroic use of 
strychnine, when, but for the drug, they would have died. The 
functional irregularity of the heart's action accompanying hysteria , 
hypochondriasis , and pregnancy is greatly relieved by moderate 
doses of tincture of nux vomica. 

As a tonic in chlorosis and anemia strychnine is an esteemed rem- 
edy, being, in the author's opinion, the best we possess in general 
efficiency. It improves the appetite, prevents putrefactive changes, 
and aids digestion, thereby enabling the patient to partake of and 
assimilate more nutriment. It also increases the force of the heart, 
quickens the circulation, and raises arterial tension, nourishing all 
parts of the body and rendering the condition more favorable for 
oxidation in the tissues and for the removal of waste products. 
The amount of urine is increased, constipation is relieved, and thus 
elimination of these products facilitated. 

Oxidation is further enhanced by the increased respiratory 
movements, rendering the blood richer in oxygen and increasing 
the number of the red corpuscles. 



MOTOR EXCITANTS. 497 

The potent action of strychnine upon the nervous system stimu- 
lates the spinal cord, giving the patient greater strength, and, by 
invigorating the brain, animating him with cheerfulness and con- 
fidence and a disposal to exercise. 

Strychnine, then, is at once a gastric, vascular, nervous, mus- 
cular, and respiratory tonic, being an invaluable remedy in debility 
from any cause. 

In bronchial and neurotic asthma, as well as in many forms of 
neuralgia, particularly the visceral variety, the drug is an efficient 
remedy. In bronchitis also, and to relieve the coughs of neurotic 
origin, it is of great value. 

Paralysis of spinal origin — paraplegia, etc. — and hemiplegia pre- 
vious to degeneration, with complete relaxation of the muscles, are 
benefited by strychnine, although in the latter affection it is of little 
if any value in recent cases or when the muscles do not respond to 
the electric current. 

The sphincters of the body, although belonging to the unstriped 
muscles, are more or less under the control of the will ; still, when 
there is an atonic condition of these structures, as in incontinence 
of urine, due to weakness of the sphincter, strychnine is a very 
powerful remedy. For the same remedial properties it is equally 
valuable in retention of urine when the detrusor muscle is too weak 
to empty the bladder. 

Probably no other drug equals strychnine in diphtheritic paraly- 
sis, the form of the disease most benefited by the remedy. It is of 
use, however, in all varieties of functional paralysis, such as those 
resulting from hysteria, mental emotion, alcoholism, venereal ex- 
cesses, the abuse of opium, lead-poisoning, gout, rheumatism, 
concussion of the spinal marrow, etc. 

Jewell claims that strychnine has caused an improvement in 
myelitis after the failure of other remedies. 

The weak and semi-paralyitic condition sometimes induced by 
bromides is improved by strychnine. 

Strychnine is exceedingly efficacious in amaurosis due to exces- 
sive use of alcohol or tobacco, being also valuable in paresis of the 
ocular muscles. Night-blindness is also greatly benefited by this 
drug. 

It is of undoubted merit in delirium tremens, as well as in pre- 
venting the usual effects of alcoholic intoxication ; in fact, the drug 
is one of the best remedies in the treatment of alcoholism, the 
strychnine nitrate being usually employed, hypodermically. Ac- 



498 A TEXT-BOOK OF MATERIA MEDICA. 

cording to the best authorities on dipsomania, strychnine seems to 
be a true antagonist to the untoward action of alcohol, and it is 
probably the important constituent of the numerous " cures " for 
the alcohol habit. 

No less valuable is strychnine in the treatment of acute poisoning 
by chloral, morphine, and physostigmine. 

As an aphrodisiac it is of unquestioned value in functional sper- 
matorrhea, and it is thought to produce contractions of the gravid 
uterus and cause abortion or premature delivery. When a predis- 
position to post-partum hemorrhage exists, the administration of 
strychnine may prove of great service. , 

Finally, strychnine has been highly recommended in the night- 
sweats of phthisis and in diabetes mellitus. 

Contraindications. — Strychnine is contraindicated in acute 
inflammatory conditions of the spinal cord and excessive reflex 
irritability. 

Administration. — The extract of nux vomica, the tincture, the 
fluid extract, or the alkaloid strychnine may be given and gradually 
increased, a tolerance by the system being rapidly established. The 
salts of strychnine are preferable to other preparations, the crude 
drug and its preparations varying greatly in strength, io minims 
(0.6 Cc.) of one tincture sometimes containing as large a percent- 
age of strychnine as 20 minims (1.2 Cc.) of another. 

The drug should be cautiously administered to children, the 
initial dose for a child five or six years of age not exceeding 
j^q grain (0.0006 Gm.). 

In using strychnine hypodermically the soluble hypodermic 
tablets should be freshly dissolved in distilled water. 

The solutions of strychnine and of the other alkaloids should 
not be kept in stock, as they become contaminated with microscopic 
plants. 

Cocculus— Cocculi— Cocculus Indicus. 

(Fish Berry.) 

Origin. — The dried fruit of Anamirta Cocculus Wright and 
Arnott, a climbing shrub in Eastern India, native to the Malabar 
coast. 

Description and Properties. — A globular, kidney-shaped, one- 
celled berry, about \ inch (6 Mm.) in diameter and f inch (10 Mm.) 
in length, blackish-brown and wrinkled. The seed is very bitter, 
but the pericarp is tasteless. The chief constituent is picrotoxin, 



MOTOR EXCITANTS. 499 

the poisonous principle contained in the kernel and first isolated 
by Boullay in 1 8 19. 

The crude drug is not used internally. 

Unofficial Preparations. 

Tinctura C6cculi— Tincturae Cbcculi — Tincture of Cocculus. — Dose, 2-20 
minims (0.12-1.2 Cc). 

Extractum C6cculi Fluidum — Extr^cti C6cculi Fluidi — Fluid Extract of 
Cocculus. — Dose, 1-3 minims (0.06-0.2 Cc). 

Picrotoxinum—Picrotoxini— Picrotoxin. TJ. S.P. 

Origin. — A neutral principle obtained from the seed of Ana- 
mirta paniculata Colebrooke. 

Description and Properties. — Colorless, flexible, shining, pris- 
matic crystals, or a micro-crystalline powder, odorless and having 
a very bitter taste ; permanent in the air. Soluble in 240 parts of 
water and in 9 parts of alcohol. 

Dose. — 6 * 4 ^ grain (0.001-0.002 Gm.). 

Antagonists and Incompatibles. — Chloral, the motor depres- 
sants, acetic acid, and the anesthetics antagonize the effects of 
picrotoxin. 

Synergists. — -All the motor excitants. 

Physiological Action. — Externally and Locally. — It is a power- 
ful parasiticide, being very destructive to lower forms of animal life. 

Internally. — Digestive System. — In small medicinal doses its 
action is similar to that of strychnine. 

Circulatory System. — Its general effects do not differ essentially 
from those of strychnine. 

Nervous System. — Picrotoxin differs somewhat from strychnine 
in its action upon the nervous system, poisonous doses producing 
epileptiform convulsions and spasms of the flexor muscles, alter- 
nating from tonic to clonic, whereas the spasms induced by 
strychnine affect principally the extensor muscles and are tonic in 
character. The brain also is differently affected — toxic doses 
resulting in stupor, delirium, coma, and complete insensibility. 

Respiratory System. — Picrotoxin tends to stimulate the respira- 
tory center, its general influence being analogous to that of 
strychnine. 

Absorption and Elimination. — The drug is rapidly absorbed, and, 
as in the case of strychnine, is eliminated chiefly by the kidneys, 
the sweat being also a channel of excretion, since cocculus, even 
more than strychnine, acts as a powerful diaphoretic. 



500 A TEXT-BOOK OF MA TERIA MEDICA. ■ 

Temperature. — No special action has been noted, though the 
temperature may be raised slightly during the convulsive period. 

Eye. — The pupils are dilated during the tonic and contracted 
during the clonic spasms. An ophthalmoscopic examination shows 
a marked hyperemia of the ocular fundus. 

Poisoning. — The drug produces muscular twitchings, incoordi- 
nation, great restlessness, tonic convulsions, with opisthotonos or 
emprosthotonos, alternating with clonic spasms and succeeded by 
paralysis, delirium, and coma. The respiratory apparatus is affected 
as in strychnine-poisoning, the symptoms being very similar to 
those of an epileptic seizure. 

Treatment of Poisoni?tg. — This is identical with that prescribed 
in cases of poisoning by strychnine. 

Therapeutics. — Externally and Locally. — The most important 
use of cocculus locally is in the treatment of parasitic and skin dis- 
eases, an ointment of picrotoxin — 10 grains to I ounce (0.6-32.0 
Gm.) — being employed for this purpose. Caution should be used 
in applying it to abraded surfaces lest poisoning result. 

The decoction or tincture of cocculus Indicus is very effective 
in destroying parasitic vermin infesting the head and body. 

Internally. — Picrotoxin has been used, although less success- 
fully, for many diseases treated with strychnine, especially paralysis 
of the extremities and of the sphincters. 

Planat has highly recommended the use of cocculus in epilepsy ; 
the best results in this disease, however, are obtained in the treat- 
ment of the nocturnal variety. The same authority advised the 
employment of the drug in chorea, infantile eclampsia, and chronic 
spasm of the limbs. 

Bartholow suggested that the drug, like strychnine, would prove 
valuable in intestinal torpor. 

Bokai has advocated its use in opium- poisoning. 

Unquestionably, its most valuable action is in controlling the 
night-sweats of phthisis. Mirrell, who first used it for this purpose, 
reported but one failure in twenty. Gubler has succeeded in 
greatly benefiting glosso-labio-laryngeal paralysis by the hypo- 
dermic injection of ■£% grain (0.00 1 Gm.) of picrotoxin. 

Dysmenorrhea and migraine occurring at the menstrual period 
are said to be greatly relieved by this drug. Even sero-purulent 
leucorrhea, it is claimed, has derived benefit from the administration 
of some preparation of cocculus. 



MOTOR EXCITANTS. 501 

Contraindications. — Similar to those for strychnine. 

Administration. — The picrotoxin is far preferable to other 
preparations of cocculus, both for external and internal use. It 
should be very cautiously administered, however. 



E rgot a— E rgot ae— E rgot . TJ. S. P. 

(Ergot of Rye.) 

Origin. — The sclerotium of Claviceps purpurea (Fries) Tulasne 
(Fungi), replacing the grain of rye, Secale cereale L. Most of the 
commercial article comes from Spain and Russia. 

Description and Properties. — Somewhat fusiform, obtusely 
triangular, usually curved, about f to 1^ inches (2-3 Cm.) long and 
\ inch (3 Mm.) thick ; three-furrowed, obtuse at both ends, purplish- 
black, internally whitish, with some purplish striae, breaking with a 
short fracture ; odor peculiar, heavy, increased by trituration with 
potassium or sodium hydrate T. S. ; taste oily and disagreeable. 
Old ergot, which breaks with a sharp snap, is almost or entirely 
devoid of a pinkish tinge in the fracture, is hard and brittle between 
the teeth, and comparatively odorless and tasteless — should be 
rejected. 

Ergot should be but moderately dried and preserved in a close 
vessel, with a few drops of chloroform added from time to time to 
prevent the development of insects. When more than one year 
old it is unfit for use. 

The active constituents of ergot are not definitely ascertained. 
It contains, however, an acid soluble in water and variously termed 
sclerotinic, ergotinic, and ergotic acid, and another, soluble in alka- 
lies, known as sphacelic acid. Both of these acids possess ecbolic 
properties. Ergot also contains a principle known as comutine, and 
30 per cent, of a yellow non-drying saponifiable fixed oil, besides 
proteids, sugar, tannin, and ash. The commercial ergotin is merely 
a purified aqueous extract of ergot. 

Jacobj has recently isolated two bodies : one, sphacelotoxin, 
which produces gangrenous effects, and chrysotoxin, which acts 
somewhat like Robert's cornutine. 

Dose. — 5-60 grains (0.30-4.0 Gm.). 

Official Preparations. 

Extraxtum Ergotae— Extract! Ergotae— Extract of Ergot.— Dose, 2-10 grains 
(0.12-0.06 Gm.). 



502 A TEXT-BOOK OF MATERIA MEDICA. 

Extr^ctum Ergotae Fluidum— Extr&cti Ergotae Fluidi— Fluid Extract of 
Ergot. — Dose, 15-60 minims (1.0-4.0 Cc). 

Vinum Ergotae — Vini Ergotae — Wine of Ergot. — Dose, 1-3 fluidrachms (4.0- 
12.0 Cc). 

Unofficial Preparations. 

Tinctiira Ergotae — Tincturae Ergotae — Tincture of Ergot. — Dose, |-2 fluid- 
drachms (2.0-8.0 Cc). 

Ergotin (Bonjean's). — Dose, 2-8 grains (0.012-0.5 Gm.). 

Antagonists and Incompatibles. — The cardiac and motor 
depressants antagonize the action of ergot. Caustic alkalies and 
metallic salts are chemically incompatible. 

Synergists. — Its action upon the circulation is aided by digitalis 
and belladonna; upon the nervous system by strychnine; while 
ustilago, hydrastine, gossypium, and the emmenagogues enhance 
its influence upon the uterus. 

Physiological Action. — Externally and Locally. — Ergot has no 
distinctive action upon the skin, but upon mucous membranes its 
influence is that of an astringent, possessing hemostatic properties. 

Internally. — Digestive System. — In large doses it is a gastro- 
intestinal irritant, occasioning considerable heat and dryness of the 
throat, accompanied by thirst and succeeded by pain in the stom- 
ach and bowels, vomiting, and occasionally purging, with violent 
peristalsis, although constipation is the commoner sequence. 

Circulatory System. — Repeated medicinal doses increase the 
blood-pressure, although rendering the pulse slower and smaller — 
the result primarily of stimulation of the vaso-motor center, fol- 
lowed by peripheral action, causing a tonic contraction of the 
small unstriped muscle fibers. 

A poisonous dose lowers arterial tension, causing the pulse to 
beat faster and softer — an effect due to exhaustion from over- 
stimulation or to direct depressant action upon the heart-muscle. 
It is claimed by competent authority that there is no active and 
actual contraction of the arteries, the result of stimulation of the 
vaso-motor system, but that the arteries contract because of the 
fulness of the veins, there not being sufficient blood to fill both 
systems, manned arterial anemia consequently resulting. It must 
be admitted that the true physiological action upon the circulatory 
system is not yet generally understood, being still sub judice, since 
equally competent pharmacologists maintain that the arterial pres- 
sure is increased as explained above. 

It is an undisputed fact, however, that the cardiac muscle is 



MOTOR EXCITANTS. 503 

actually contracted by ergot. Indeed, Willebrand claims that " the 
normal or hypertrophied heart so contracts under the action of 
ergot that the difference in size is appreciable by percussion " 
(Bartholow). 

If any changes are produced by this drug in the composition 
of the blood, they have not been ascertained. 

Nervous System. — Medicinal doses have no especial action, 
though excessive doses sometimes depress the sensory mechanism, 
producing general cutaneous anesthesia. 

The action of toxic doses on the nervous system will be 
described under " Poisoning." 

Respiratory System. — Medicinal doses produce no particular 
effect. Large doses depress the respiratory center, rendering the 
breathing shallow. This action is manifest from the first, there being 
no primary stimulation of the respiration. Death from an overdose 
of ergot usually results from paralysis of the respiratory center. 

Absorption and Elimination. — The active constituents of ergot 
are rapidly absorbed into the blood, and are eliminated principally 
by the kidneys, increasing the urinary flow. 

Temperature. — No special action has been observed. 

Eye. — The caliber of the retinal and nutrient opticus blood- 
vessels is reduced, resulting in marked pallor of the disk, transitory 
amblyopia, and papillary anemia. 

Uterus. — Probably the most important action of ergot is upon 
this organ. It produces in full doses tetanic, tonic contraction of 
the uterine muscle, the uterus becoming hard and pale, and forcing 
the blood out of the uterine arterioles. The organ is more sensi- 
tive to the action of the drug during pregnancy. 

The precise manner in which ergot affects the uterus is still 
a matter of discussion. It is fairly demonstrated, however, that 
the drug acts both centrally and peripherally, owing to its different 
constituents, cornutin acting centrally and sclerotinic acid periph- 
erally. The drug causes a contraction of involuntary muscles 
throughout the body. 

It is doubtful if any drug in our Materia Medica has been more 
carefully studied than ergot, and, if opinions differ widely as to its 
modus operandi, it is because we have to deal with a very complex 
substance, the nature, and even the number, of whose constituents 
are as yet inadequately known. Many principles of the drug are 
unstable and variable in their action, certain preparations differing 
decidedly from others in their influence, as, for instance, Tanret's 
ergotinine, which has no effect upon the uterus. Bonjean's ergotin 



504 A TEXT-BOOK OF MA TERIA MEDICA. 

is a powerful ecbolic, and has a marked action, moreover, upon the 
vascular system, whereas Wigger's ergotin is inert. 

Untoward Action. — In addition to the gastro-intestinal disturb- 
ances already described, there are occasionally produced headache, 
mental confusion, dizziness, a feeling of chilliness, muscular weak- 
ness, dilatation of pupils, and glimmering before the eyes. 

Poisoning. — There are two varieties of ergot-poisoning, acute 
and chronic. Under the administration of immoderate doses pecu- 
liar symptoms appear, known collectively as acute ergotism. Rest- 
lessness, mental worry, headache, tinnitus aurium, dilatation of the 
pupils, pallor and coldness of the skin, and other effects are present. 
At times cutaneous anesthesia is manifest or general formication. 
Epileptiform spasms, great reduction of respiration and temperature, 
may occur, while obstruction of cardiac movements, with sudden 
nausea and violent vomiting, and other alarming manifestations, 
attest the untoward properties of the drug. 

Chronic ergotism is confined chiefly to Europe, where ergotized 
rye is used in bread-making. The disease is marked by convulsive 
or gangrenous conditions. 

The first variety, the convulsive, is characterized by paroxysmal 
spasms of the flexor muscles, which later become continuous, re- 
sulting in opisthotonos or emprosthotonos. There is dimness of 
vision, while an increasing intensity of symptoms develops affection 
of other special senses, those of hearing and smell being either im- 
paired or temporarily lost. Violent abdominal cramps also occur, to- 
gether with painful dyspnea, death resulting from asphyxia or coma. 

The second (gangrenous) form is signalized by severity of local 
phenomena, profound dyscrasia, formication or cutaneous anes- 
thesia, impairment of special senses, and numbness of the muscles 
or extremities, followed by sloughing or atrophy of the diseased 
parts and mummification or dry or moist gangrene. 

Fatal results of chronic ergotism are usually traceable to the 
convulsions, although moist or dry gangrene may in certain cases 
produce death. 

A form of ergotism is peculiar to Lombardy, Italy, occasioned 
by chronic poisoning with diseased or fermented maize, and affect- 
ing principally the cerebro-spinal and digestive systems. It causes 
an acute erythema, which extends rapidly and is attended with 
much swelling, together with an extreme sensation of burning or 
itching. Pronounced nervous and general symptoms are present, 
and the malady not infrequently results in insanity or melancholia. 

Treatment of Poisoning. — Symptoms of acute poisoning may be 



MOTOR EXCITANTS. 505 

alleviated by hot baths and the administration of tannic acid and 
cardiac stimulants. For the treatment of chronic ergotism hygienic 
measures and symptomatic remedies are indicated. 

Therapeutics. — Externally and Locally. — In the form of lozenges 
or diluted fluid extract the drug has been employed in acute 
pharyngitis. The hypodermic injections of ergotin are valua- 
ble in nasal hypertrophies , prolapsus of the rectum, hemorrhoids, 
enlargement of the prostate gland, aneurysm, varicocele, and vari- 
cose veins. 

Internally. — The most important medical use of ergot is to 
promote uterine contractions in labor. The preponderance of 
testimony among the most experienced obstetricians is in favor of 
its use only after the expulsion of the uterine contents. This is a 
rule, however, which cannot be invariably followed. While the 
employment of the drug is contraindicated in the first stage of 
labor, it may be safely employed during the second stage, when 
there is uterine inertia, provided all the parts be in a normal 
condition and there exists no mechanical impediment to the rapid 
delivery of the child. Ergot is of service also when the placenta 
is retained owing to inefficient and feeble uterine contractions. 

With these exceptions it is customary — and the author concurs 
in the procedure — to delay the administration of the drug until the 
expulsion of the placenta, when a full dose of the fluid extract is 
given, or ergotin hypodermically. When ergot is administered 
during the second stage of labor, it should be given in small doses, 
so as to promote intermittent rather than continuous contractions 
of the uterus. No drug possesses so energetic and prompt an 
action as ergot in post-partum and uterine hemorrhage. It is an 
exceedingly efficacious remedy also in subinvolution and in uterine 
fibroids and polypi. 

The accompanying diagrams will illustrate the control of hemor- 
rhage through the contraction of the uterine muscle and arterioles, 
and the influence of ergot upon submucous fibroid tumors by 
mechanical compression and consequent diminution of their blood- 
supply. It is obvious that the location of a subperitoneal tumor 
is such that the drug cannot influence its growth as it can a sub- 
mucous fibroid. 

This remedy is also extremely useful in the treatment of ple- 
thoric amenorrhea, congestive dysmenorrliea, menorrJiagia, chronic 
metritis, etc. 

Dilatation of the cardiac cavities without valvular lesion is 
much improved by the administration of ergot ; the remedy has 



506 



A TEXT-BOOK OF MATERIA MEDIC A. 



also been employed with considerable success in chronic diarrhea 
and dysentery. 

Incontinence of urine — depending either upon enlarged prostate, 
irritability, or a paretic or paralytic condition of the bladder — is 





Fig. 6. — Diagram showing how ergot reduces 
uterine hemorrhage: A, uterine muscle; B, B, 
arteries. 



Fig. 7. — Diagram showing how ergot reduces 
the size of a submucous fibroid, but has no effect 
upon a subperitoneal fibroid : A, uterine muscle ; 
B, subperitoneal fibroid ; C, submucous fibroid ; 
D, D, arteries. 



greatly relieved by this remedy. The atonic form of spermatorrhea 
is palliated or cured by ergot. 

The drug is of value also in cerebral hyperemia and consequent 
mania, as well as in cerebrospinal meningitis, congestion of the 
spine, myelitis, and congestive headaches. 

Ergot has been highly recommended, notably by Dr. J. M. Da 
Costa, in diabetes insipidus, and by such authorities as Heltzmann 
and D'Enslow in prurigo, erythema, urticaria, and acne rosacea. 

Owing to the peculiar action of ergot upon unstriped muscular 
fiber it is a valuable drug in various forms of hemorrhage. 

The diseases mentioned as being favorably influenced by the 
local application yield as readily perhaps to the internal administra- 
tion of ergot. 

Finally, this remedy has met with some success in the treatment 
of leucorrhea, galactorrhea, hypostatic congestion of the lungs, whoop- 
ing cough, the different varieties of purpura, colliquative sweats, 
splenic enlargements, and exophthalmic goiter. 

Contraindications. — During the first stage of labor and in 
cerebral or spinal anemia. 

Administration. — For its action upon the uterus a valuable 



MOTOR EXCITANTS. 507 

fluid extract is the best preparation as an internal remedy ; for 
hypodermic use the aqueous extract (ergotin) or some of the 
non-alcoholic fluid preparations manufactured by certain reliable 
pharmacists for this particular purpose, should be employed. 
Ergotin may be incorporated in suppositories when for any reason 
it is desirable to administer the drug per rectum. 

Gossypii Radicis Cortex— Gossypii Radicis Corticis— 
Cotton Root Bark. TJ. S. I>. 

Origin. — The bark of the root of Gossypium herbaceum L. and 
of other species of the genus, indigenous in the tropical and sub- 
tropical regions of Asia and Africa. The plant has been cultivated 
in the United States and other countries from a very early period, 
many characteristic varieties having been produced. 

Description and Properties. — It occurs in thin, flexible bands 
or quilled pieces, the outer surface brownish-yellow, with slight 
longitudinal ridges or meshes, small, black circular dots, or short, 
transverse lines, and dull, brownish-orange patches, from the abra- 
sion of the thin cork; inner surface whitish, of a silky lustre, finely 
striate ; bast-fibers long, tough, and separable into papeiy layers ; 
inodorous ; taste very slightly acrid and faintly astringent. 

It contains a fixed oil, a small quantity of tannin, sugar, and 
starch, a yellow resin, and, in the fresh bark, a pale-yellow chromo- 
gene, soluble in alcohol, which on exposure to air becomes red 
and resinous. 

Dose. — 15-60 grains (1.04-4.0 Gm.). 

Official Preparation. 

Extractum Gossypii Radicis Fluidum — ExtrScti Gossypii Radicis Fluidi — 
Fluid Extract of Cotton Root Bark.— Dose, \-\ fluidrachm (1.8-3.7 Cc). 

Antagonists and Incompatibles. — The same as for ergot. 

Synergists. — Ergot and its synergists. 

Physiological Action. — Identical with that of ergot, but infe- 
rior in certainty of action. 

Therapeutics. — Cotton root bark is employed only for its action 
upon the uterine system, in which respect it is identical with ergot. 
An exception may possibly be in its use in the treatment of subin- 
volution and tumors of the uterus, in which cases it is less efficient 
than ergot. 

Contraindications. — The same as for ergot. 

Administration. — The fluid extract only should be employed. 



508 A TEXT-BOOK OF MA TERIA MEDICA. 

Hydrastis— Hydrastis— Hydrastis. JJ. S. P. 

(Golden Seal.) 

Origin. — The rhizome and roots of Hydrastis Canadensis L., a 
perennial native to Canada and the United States east of the Mis- 
sissippi, growing in rich woodlands and in the Southern States, 
confined to mountainous districts. 

Description and Properties. — The rhizome is from I to 2 
inches (2-5 Cm.) long and about \ inch (6 Mm.) thick, oblique, 
with short branches, somewhat annulate and longitudinally 
wrinkled; externally brownish-gray; fracture short, waxy, red- 
dish-yellow, with a thickish bark, about ten narrow wood-wedges, 
broad medullary rays, and large pith. Roots thin, brittle, with a 
thick yellow bark and subquadrangular woody centre. Odor 
slight, taste bitter. 

The principal constituents are hydrasiine (colorless and slightly 
acrid) and berberine (yellow and intensely bitter), the latter alkaloid 
being also found in berberis, Colombo, menispermum, coptis, etc. 
There is a yellow resinoid (hydrastin) on the market which should 
not be confounded with the active alkaloid hydrastine. 

Dose. — The crude drug is not given internally. 

Official Preparations. 

Extr^ctum Hydrastis Fluidum — Extr&cti Hydrastis Fliiidi — Fluid Extract 
of Hydrastis. — Dose, 10-30 minims (0.6-2.0 Cc). 

Glyceritum Hydrastis — Glyceriti Hydrastis — Glycerite of Hydrastis. — Used 
externally. 

Tinctura Hydrastis — Tincturae Hydrastis — Tincture of Hydrastis. — Dose, 
30-60 minims (2.0-4.0 Cc.). 

Hydrastina — Hydrastinae — Hydrastine (unofficial). — An alkaloid obtained from 
Hydrastis. 

Origin, Description, and Properties. — Colorless, very brilliant, glassy crystals ; taste 
slightly acrid ; fully soluble in ether and chloroform, but freely soluble in water. 

Dose. — ^-l grain (0.002-0.03 Gm.). 

Hydrastinmse Hydrochloras— Hy drastininse Hydrochloratis — Hydrastinine 
Hydrochlorate. U. S. P. — Origin. — The hydrochlorate of an artificial alkaloid de- 
rived from Hydrastine. 

Description and Properties. — Light-yellow, amorphous granules, or a pale-yellow 
crystalline powder, odorless, and having a bitter, saline taste ; deliquescent on exposure 
to damp air. Soluble in 0.3 part of water and in 3 parts of alcohol. The product 
should be kept in well-stoppered vials. 

Dose. — jVI g^i" (0.005-0.03 Gm.). 

Antagonists and Incompatibles. — The alkalies, mineral acids, 
and tannic and other vegetable acids are incompatible with prepara- 
tions of hydrastis. The physiological antagonists are chloral, 
potassium bromide, and the motor depressants. 



MOTOR EXCITANTS. 509 

Synergists. — Quinine and the vegetable bitters aid its action 
upon the digestive tract, ergot upon the uterus, and strychnine 
upon the spinal cord. 

Physiological Action. — Externally and Locally. — Hydrastine 
possesses little or no action when applied locally, and upon the 
eye its effect is to contract and afterward dilate the pupil. 

Internally. — Digestive System. — Its action resembles that of 
strychnine, though excessive doses produce greater gastric dis- 
turbance, almost invariably occasioning vomiting. 

Circulatory System. — Its influence is similar to that of strych- 
nine, but not so powerful. In its effect upon the white blood-cor- 
puscles it resembles quinine, arresting their movements. 

Nervous System. — Here also the action of hydrastis is analogous 
to that of strychnine, although it is much less powerful, while more 
persistent. It differs from its congener, however, in its effect upon 
the sensory nerve-fibers, very large doses impairing their func- 
tional activity, 

Respiratory System. — In its action upon the respiratory system 
it resembles strychnine, differing in no essential particular. 

Absorption and Elimination. — It is slowly absorbed, tending to 
accumulate in the system. It is eliminated chiefly by the kidneys, 
increasing slightly the urinary flow. 

Temperature. — Medicinal doses have no effect ; poisonous doses 
decrease bodily heat. 

Eye. — It has no particular action upon the eye, other than to 
first contract and then dilate the pupil when directly applied. 

Uterus. — Hydrastine is a feeble oxytocic, affecting the womb in 
a manner similar to, though much less powerful than, ergot. 

Untoward Action. — The untoward manifestations are essentially 
those of poisoning. 

Poisoning. — The symptoms are almost identical with those of 
strychnine. 

Treatment of Poisoning. — The same as that of poisoning by 
strychnine. 

Therapeutics. — Externally and Locally. — Hydrastin (the yellow 
resinoid) — in the proportion of 5 grains (0.3 Gm.) to 1 ounce (30.0 
Cc.) of water, or the fluid extract of hydrastis, 15 to 20 minims 
( 1. 0-1.2 Cc.) to 4 ounces (118 Cc.) of water — makes an efficient 
injection in gonorrhea. 

Hydrastine (the alkaloid), or, preferably, hydrastine hydro- 



510 A TEXT-BOOK OF MA TERIA MEDICA. 

chlorate — 3 grains (1.2 Gm.) to 1 ounce (30.0 Cc.) of glycerin — 
affords great relief in certain forms of chronic conjunctivitis. 

Hydrastis is a valuable remedy in catarrh of the upper respira- 
tory tract. 

The tincture — 1 fluidrachm (3.7 Cc.) to 1 ounce (30.0 Cc.) of 
water — is a valuable mouth- wash in all indolent and offensive ulcera- 
tions of the mouth and throat, such as syphilitic and mercurial affec- 
tions, follicular pharyngitis, etc. 

The fluid extract serves a useful purpose in the local treatment 
of anal fissure and of rectal ulcer, vaginal and uterine ulcerations, 
and leucorrhea. Indolent ulcers anywhere, and chancres and chan- 
croids, are stimulated to a healthier condition by the application of 
this preparation. 

An ointment of hydrastine hydrochlorate, in strength vary- 
ing from 5-30 grains (0.3-2.0 Gm.) to 1 ounce (32.0 Gm.) of simple 
ointment, affords an efficient local application in acne and seborrhea 
sicca, and the same preparation makes a serviceable dressing for 
ulcerated carcinoma and bromidrosis. 

The distilled extract of witch-hazel with hydrastine hydro- 
chlorate is recommended in hyperidrosis. 

Palmer has successfully employed inhalations of a solution of 1 
part of the extract to 3 parts of salt water in tubercular and simple 
bronchitis.. 

The topical action of hydrastis and its preparations is that of an 
antiseptic and tonic, strengthening the circulation and nutrition, 
rendering the drug peculiarly valuable in diseases of mucous sur- 
faces. 

Internally. — As a remedy for diseased conditions of the stomach 
and bowels it is of much the same value as the vegetable bitters, 
and may be used for the same purposes. 

Hydrastine possesses considerable antiperiodic power, having 
been employed in intermittent fever and chronic malaria, though 
much inferior to quinine, and probably also to arsenic. Its bene- 
ficial action in these conditions is undoubtedly due to its power to 
increase the functional activity of the liver, this influence also ren- 
dering it valuable in chronic constipation induced by hepatic inac- 
tivity — catarrhal jaundice, too, being frequently relieved by the 
remedy. 

Hydrastine, more especially hydrastine hydrochlorate, acts 
upon the uterus very much like ergot, and has been highly recom- 
mended by well-known authorities in uterine hemorrhage and other 



MOTOR EXCITANTS. 5 11 

uterine disorders for which ergot is used. By careful observers, of 
experience with the drug, it is considered superior to ergot in the 
hemorrhage of puberty and the menopause, as well as in congestive 
dysmenorrhea. 

Koniger has treated hemoptysis successfully with the fluid 
extract in 20- or 30-minim (1.2-2.0 Cc.) doses, repeated several 
times a day. The drug has proved equally beneficial in arresting 
the night-sweats of phthisis, and is an efficient substitute for alco- 
holic stimulants when their use is abandoned. 

Hydrastine hydrochlorate has recently been favorably men- 
tioned as a remedy for epilepsy. 

Contraindications. — The same as for vegetable bitters, strych- 
nine, and ergot. 

Administration. — When taken for its action upon the stomach 
and bowels it should be given before meals ; for its effect on the 
uterus it is best administered in divided doses or the hydrastine 
hydrochlorate hypodermically. 

Cotarnine is a synthetic product from narcotin, and used as a 
styptic and in uterine hemorrhage in ^-grain doses thrice daily or 
oftener. 

Rhus Toxicodendron— Rhois Toxicodendri— Rhus 
Toxicodendron. TJ. S. I*. 

(Poison Ivy.) 

Origin. — The fresh leaves of Rhus radicans L., a climbing shrub 
indigenous in Canada and the greater part of the United States 
westward to the Rocky Mountains. 

Description and Properties. — Long-petiolate, trifoliate, the lat- 
eral leaflets sessile or nearly so, about 4 inches (10 Cm.) long, 
obliquely ovate, pointed; the terminal leaflets stalked, ovate or 
oval, pointed, with a wedge-shaped or rounded base ; the leaflets 
entire and glabrous or variously notched, coarsely toothed, or lobed, 
more or less downy ; when dry papery and brittle; inodorous ; taste 
somewhat astringent and acrid. The fresh leaves abound in an 
acrid juice which darkens on exposure to air, and when applied to 
the skin produces inflammation and swelling. The leaves should 
therefore not be touched with the bare hands. 

The fresh leaves contain a volatile acid (toxicodendric), which 
is almost entirely absent in the dried leaves. In addition to this 
active constituent the leaves contain tannin. 



512 A TEXT-BOOK OF MATERIA MEDIC A. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Unofficial Preparation. 
Tinctura Rhois ToxicodSndri — Tincturae Rhois ToxicodSndri — Tincture of 
Toxicodendron. — Dose, T V- 2 minims (0.006-0.12 Cc). Prepared from fresh plants 
— 1 part of fresh leaves to 2 parts of alcohol. 

Physiological Action. — Externally and Locally. — The fresh 
leaves of this common plant are extremely irritant to the skin, 
generally acting as a marked vesicant and establishing severe local 
inflammation, manifested by acute dermatitis, excessive edema, and 
hyperemia. In many cases these effects are much less pronounced, 
while in certain individuals they are never occasioned by contact 
with or even chewing the leaves. As with poison sumach — Rhus 
venenata — the toxic influence of the plant derived from local 
application is apparently more virulent during the period of 
florescence. 

The inflammation somewhat resembles erysipelas, being rapidly 
diffused and accompanied by a general systemic disturbance, in- 
cluding abdominal pains, nausea, and vomiting, with perhaps diar- 
rhea, diuresis, and serous passages. Profuse diaphoresis and lum- 
bar and articular pains may also result. These symptoms cease 
after about ten days or a fortnight without other sequel than 
desquamation of the affected surface. 

Internally. — The effects of the drug administered internally are 
to cause gastro-intestinal inflammation, with drowsiness and stupor, 
and occasionally delirium and convulsions. Vertigo, nausea, chilli- 
ness, thirst, weak and irregular cardiac movements, diaphoresis, 
muscular debility, and diuresis are also reported. Dilatation of the 
pupils is also a result of ingestion or internal absorption, and an 
illustration of the virulence of the drug is seen in the fact that even 
air impregnated with exhalations from the leaves may cause epi- 
dermic eruption, while the berries have produced serious symptoms 
in the spinal and cerebral systems, and in an authentic case the 
root has proved notably fatal. 

Treatment of Poisoning. — Many remedies have been used, with 
varying efficacy, to allay the toxic effects of the drug. Dermal 
poisoning has been relieved by glycerite of carbolic acid or alkaline 
lotions. In the earlier stage of external irritation warm soapsuds 
and sodium bicarbonate have been successfully applied. Alum- 
curd, ammonia in weak solution, solution of chlorinated soda, and 



MOTOR EXCITANTS. 513 

many other agents have been employed to meet the requirements 
of certain stages of the affection. A solution of cocaine, 4 to 8 
per cent, quickly relieves the cutaneous irritation ; a liquid prepara- 
tion of grindelia robusta makes a grateful application ; while opium, 
coffee, and laxatives would be indicated. 

Therapeutics. — Externally and Locally. — The diluted tincture — 
8 minims (0.5 Cc.) to 4 ounces (118 Cc.) of water — has met with 
some favor, as has been stated, in the treatment of sprains, burns, 
etc. 

In weak solution with alcohol the remedy has been used as 
a stimulating application in cases of sprains, chilblains, burns, 
insect-stings, etc. 

Internally. — It has been recommended in rheumatic affections of 
fibrous tissues, paralysis, erysipelas, herpes zoster, pemphigus, eczema, 
and erythema. 

Dr. Rothrock believes it to be a valuable cerebro-spinal stimu- 
lant. 

It has been supported as a strong palliative or cure in inconti- 
nence of urine depending upon atony of the bladder. 

It is evident that the drug needs to be much more thoroughly 
investigated, there being widely diverse opinions regarding its thera- 
peutic value. There is, however, sufficient testimony in its favor 
from competent authorities to justify further examination and use 
of this extremely active remedy. 

Contraindications. — The meager knowledge we possess re- 
specting its true action in disease renders it impossible to mention 
any special contraindication to its employment. 

Administration. — The tincture is the only preparation used, 
and should be cautiously administered. 

Coca— Cocae— Coca. TJ. S. _P. 

Origin. — The leaves of Erythroxylon Coca Lam., a shrub about 
6 feet (1.8 M.) high, with numerous spreading purplish-brown 
branches, bearing bright green leaves varying in size according to 
the nature of the plant or of the soil in which it grows. The 
flowers, found either alone or in clusters, are small, regular, her- 
maphrodite, white or greenish-yellow, being succeeded by small 
scarlet berries. 

Coca is indigenous in the mountains of Peru and Boliva, and 
on the eastern slopes of the Andes is cultivated in damp, warm 
valleys from 3000 to 6000 feet (9 14. 5- 1829 M.) above the sea- 
33 



514 A TEXT-BOOK OF MATERIA MEDICA. 

level, being also grown in some parts of Colombia, Brazil, the 
Argentine Republic, and the island of Java. The province of 
La Paz in Bolivia produces the largest crops, the article being 
more highly esteemed than the Peruvian variety. Cocaine, how- 
ever, is obtained from leaves of the Javanese plant. 

Description and Properties. — In size and shape the leaves 
resemble those of tea, ovate, lanceolate, or obovate-oblong, from 
f to 2 or 2\ inches (2-5 or 7 Cm.) long and 1 to i| inches (25- 
37 Mm.) broad ; short-petiolate, entire, rather obtuse or emarginate 
at the apex, slightly reticulate on both sides, with a prominent 
midrib, and on each side of it a curved line running from base to 
apex ; odor slight and tea-like, taste somewhat aromatic and bitter, 
when chewed temporarily benumbing the lips and tongue. 

The active constituent is the alkaloid cocaine. The plant also 
contains two other alkaloids — ecgonine and hygrine, and a peculiar 
tannin, coca-tannic-acid, having a green reaction upon salts of iron. 

Dose. — J-4 drachms (2.0-16.0 Gm.). 

Official Preparation. 

Extr^ctum Cocse Fluidum — Extraxti CScse Fluidi — Fluid Extract of Coca. 

— Dose, 20 minins-i fluidrachm (1.2-4.0 Cc). 

Cocaina — Cocainse — Cocaine (unofficial).— Description and Properties. — Color- 
less, prismatic crystals, of a strongly alkaline reaction. The taste is bitterish and pro- 
duces a transient numbness of the tongue. Soluble in 704 parts of water, in much less 
alcohol and ether, and in fixed oil. 

Dose. — |-l grain (0.03-0.06 Gm.). 

Cocainae Hydrochloras— Cocainae Hydrochloratis— 
Cocaine Hydrochlorate. U. S. I*. 

This is the only official salt of cocaine, and the one almost 
invariably used in medicine. 

Description and Properties. — Colorless, transparent crystals 
or a white, crystalline powder, odorless, of a saline, slightly bitter 
taste, and producing upon the tongue a tingling sensation followed 
by numbness of some minutes' duration. Permanent in air, soluble 
in 0.48 part of water and 3.5 parts of alcohol; very soluble in 
boiling water and in boiling alcohol. 

Dose. — \-2 grains (0.008-0.12 Gm.). 

Cocainae 'Fhenas— Cocainae Phenatis — Cocaine Phenate (unofficial). — This 
salt contains about 75 per cent, of the alkaloid. 

Description and Properties. — It occurs as a yellow, viscid mass. Soluble in alcohol, 
insoluble in water. 

Dose. — fa-\ grain (0.005-0.01 Gm.). 



MOTOR EXCITANTS. 515 

Antagonists and Incompatibles. — Morphine, chloral, amyl- 
nitrite, alcohol, chloroform, and ether are physiological antagonists. 
The most direct opponents are chloral and morphine. 

Cocaine is incompatible with caustic alkalies and the alkaline 
carbonates and bicarbonates, as well as with bichloride of mercury, 
iodine and the iodides, ammonia, zinc chloride, and borax. 

Synergists. — Medicinally, its cerebral effects may be enhanced 
by the cerebral stimulants, such as alcohol, cannabis Indica, and 
belladonna, while its analgesic and anesthetic action may be aided 
by carbolic acid, atropine, opium, and conium. When used as 
a mydriatic atropine serves as a valuable synergist. 

Physiological Action. — For our first knowledge of the physio- 
logical properties of coca we are indebted to its empirical use 
among the natives of Peru. The history of the drug is replete 
with interest and romance. It was regarded as the living repre- 
sentation of the Deity, the ground whereon it grew being held 
sacred. During the reign of the Incas its use was a royal privi- 
lege, the people being compelled to obtain permission from the 
governor to avail themselves of its benefits. Later it was adopted 
indiscriminately. 

The native coqueros (coca-chewers) have learned from experi- 
ence that they can climb the Andes, work laboriously in the mines, 
and endure fatigue and hunger more hardily when chewing the 
leaves of the plant, and from time immemorial the drug has been 
recognized by observers as possessing powerful nutritive, stimulant, 
and restorative properties. 

In describing the action of the crude drug the author can add 
little to the words of Linnaeus, who long ago wrote that coca 
possessed " the penetrating aroma of vegetable stimulants, the 
astricting and fortifying virtues of an astringent, the antispasmodic 
qualities of bitters, and the mucilaginous, nutritive properties of 
analeptics or of alimentary plants." " This leaf," he adds, " ex- 
hibits with energy its action on all parts of the animal economy. 
Olido in nervos, sapido in ftbras, utroqne in fluidoT 

Since the isolation of the alkaloid cocaine, to which the drug 
owes its physiological and medical properties, by Gaedeke in 1855, 
and the subsequent study of it by eminent pharmacologists and 
therapeutists, we have learned more of the physiological action of 
coca. Its effect upon different systems are here described in 
detail. 

Externally and Locally. — Cocaine is analgesic, anesthetic, and 



516 A TEXT-BOOK OF MATERIA MEDICA. 

ischemic. Upon the unbroken skin it has no action, but upon 
mucous membranes or the subcutaneous tissue it produces com- 
plete local anesthesia. The surface to which it is applied becomes 
paler than normal, owing to contraction of the blood-vessels, but 
afterward reddens and appears turgescent through secondary dila- 
tation of the vessels. The absorption of the drug by mucous 
membranes varies with the locality to which it is applied — with 
difficulty from the conjunctiva, yet with great readiness from the 
Schneiderian membrane, producing its characteristic constitutional 
effects. 

Applied to the conjunctiva, or even taken internally, cocaine 
causes a transitory contraction of the pupil, soon followed by dila- 
tation. The accommodation is impaired, but not completely de- 
stroyed, the ocular tension being lowered. 

The anesthetic action of cocaine applied locally is due to the 
depression of the ends of the sensory nerves. It dilates the pupil 
by stimulating the ends of the sympathetic nerve, which innervates 
the radiating fibers of the iris. 

In addition to its local analgesic action the drug possesses the 
power of destroying the functions of the nerves of special sense, 
so that taste and smell, as well as the tactile sense, are abolished. 
When applied locally or taken internally it primarily checks many 
of the secretions, though those from the pancreas and liver seem 
to be uninfluenced by its internal use. The secondary impression 
of cocaine, however, when the blood-vessels become dilated, is 
accompanied by increased secretion. 

Frangois-Franck, who has made an exhaustive study of the 
local action of cocaine, contends that it is " a powerful paralyzing 
poison, acting alike on sensory and motor nerve-endings, on all 
kinds of peripheral nerves, on nerve-centers, muscles, glands, 
epithelium, leucocytes, vegetable protoplasm, micro-organisms, 
etc." 

Internally. — Digestive System. — On account of its stimulant 
action upon the constrictor fibers of the great sympathetic nerve, 
under the influence of moderate doses peristalsis is largely increased 
in the stomach and intestines, very large or poisonous doses, on 
the contrary, causing great sluggishness of the bowels. 

Although it has been shown by experiments upon animals that 
cocaine is incapable of sustaining life, it diminishes in man the sen- 
sation of hunger, owing to its local anesthetic action upon the 
mucous membrane of the stomach, so that the coqueros are able to 



MOTOR EXCITANTS. 517 

abstain from food for days, thirst also being allayed. This diminu- 
tion of hunger does not seem to impair appetite and digestion, 
since food is subsequently relished and digested as well as, if not 
better than, if coca had not been used. 

Circulatory System. — Medicinal doses of cocaine increase the 
force and frequency of the cardiac contractions, and also arterial 
pressure. Large or poisonous doses render the pulse slow, soft, 
and weak, and lower arterial tension. The exact modus operandi is 
not fully determined, such eminent authorities as Mosso, Von 
Aurep. Vulpian, Ott, Nikolsky, and others differing as to its action 
upon the circulatory apparatus. It is quite probable that its action 
is similar to that of atropine in this respect. 

Nervous System. — When given internally its first action is upon 
the brain, moderate doses greatly stimulating the intellectual facul- 
ties and producing a feeling of ecstasy and well-being, in many 
respects akin to the sensations experienced under the action of 
cannabis Indica. In the course of a few hours the stage of cere- 
bral excitement is succeeded by mental, moral, and muscular 
depression. 

Toxic doses result in incoherent speech and wild delirium, 
accompanied by swaying of the head, followed by epileptiform con- 
vulsions and narcosis. The convulsions are of cerebral origin, the 
effect of cocaine upon the spinal cord being yet but imperfectly 
understood. 

The sensory nerves are depressed by small and paralyzed by 
lethal doses. The motor nerves are also depressed by large doses, 
this action, however, being subordinate to that exerted upon the 
sensory nerves. The muscles are stimulated by medicinal doses 
through impression upon the motor tracts, although large doses 
greatly depress muscular activity. The chewing of coca, as prac- 
tised by the natives of Peru and Bolivia, undoubtedly appears to 
augment muscular strength and powers of endurance. 

Mosso claims that small doses of cocaine serve as a power- 
ful muscular stimulant in cases of exhaustion from hunger or 
fatigue. 

Laffont states that cocaine possesses an "excito-functional action 
on the great sympathetic constrictor nerve, consequently an exalta- 
tion of the functional action of all the non-striated muscles or 
muscles of organic life which are subordinated to it." 

Respiratory System. — Medicinal doses powerfully stimulate the 
respiratory center, increasing the rapidity and depth of the respira- 



518 A TEXT-BOOK OF MATERIA MEDICA. 

tions. Poisonous doses paralyze the center, the result being dys- 
pnea, feeble breathing, and death from respiratory failure. 

Absorption and Elimination. — Cocaine is quickly absorbed, being 
eliminated principally by the kidneys in a form differing from its 
original nature. Much of it undergoes oxidation in the body. 
The amount of urine is increased, though the nitrogenous ele- 
ments are diminished. The habitual use of the drug lessens urinary 
secretion. 

Cocaine possesses no cumulative action, although its effects 
become more marked under repeated dosage, due probably to 
some special dynamic action upon the nervous system. 

Temperature. — Medicinal doses have no influence on bodily 
heat, but poisonous doses usually raise the temperature, owing, 
according to Reichert, to an increase of heat-production. 

Eye. — Cocaine produces a noticeable dilatation of the pupil, as 
already explained under " Local Action," the maximum change 
being reached in about an hour, and the normal state regained in 
from twelve to twenty-four hours. 

Cocaine-poisoning. — Among the more prominent physiological 
symptoms resulting from the ingestion of excessive doses of coca- 
ine or repeated and continued injections are a tendency to coma 
or collapse ; a feeble, thready pulse, often running extremely high ; 
great emaciation ; anorexia and impairment of the digestive powers ; 
and increased frequency, and again alarming depression, of respira- 
tion. There are other symptoms, scarcely less serious, which, as 
the majority of observations show, render cocaine one of the most 
generally deleterious of drugs, opium not excepted. Dropsy, ma- 
rasmus, numbness, syncope, profound malaise, muscular twitchings 
with mild convulsions, insomnia, amblyopia, mydriasis, visual hal- 
lucinations, headache, vertigo, dangerously elevated temperature, 
dental decay, and fetid breath, — even this admonitory catalogue of 
ills fails to complete the recorded phenomena attending poisoning 
from cocaine. 

Yet, grave as are the foregoing physical changes incident to an 
immoderate use of the drug, the mental and, above all, the moral 
effects of cocaine-poisoning are far more deplorable. It is a melan- 
choly but indubitable fact that to one fully committed to the so-called 
" cocaine habit " there appears at times no principle of honor or deco- 
rum to which the vitiated sensibilities are amenable. The enfeeble- 
ment of the intellectual faculties, the loss of memory, inability to 
coordinate or control ideas, a consciousness occasionally merged 



MOTOR EXCITANTS. 519 

in pronounced mania, possibly with homicidal inclination, and an 
intense selfishness of thought and purpose, in which apathy, neg- 
lect of domestic obligations, and complete debasement of nobler 
qualities are developed, — these lamentable accompaniments mani- 
fest too clearly the degenerating influences exerted by a constant 
resort to the use of this ill-fated, if not fatal, drug. 

An instance coming under the author's personal observation 
will serve to illustrate the entire lapse of the subject's morale. 
The case is that of a well-known, successful, and highly esteemed 
practitioner, who, becoming addicted to the employment of cocaine 
as an alleviation for bodily and mental depression, reached at last 
a stage of moral degradation in which he neither shrank from 
lying and stealing nor considered any means of gratifying his dis- 
eased appetite too abject — the persuasions of friends, the considera- 
tions of professional duty and social position, and the distracted 
appeals of his own family being alike unavailing to arrest the passion 
to which he had succumbed. It is grateful to record that from his 
moral turpitude the subject at length emerged triumphantly, to-day 
occupying a proud position reflecting honor upon himself and his 
profession. 

A still more distressing case, in that it was attended with fatal 
results, is that of a physician personally known to the author 
who, contracting the cocaine habit, in blind folly administered 
the drug to his wife and child, all dying within the period of a 
few months. 

The desperation to which the cocaine habitue may be driven in 
his temporary madness is shown in the case of a young man scarcely 
twenty years of age, son of an eminent surgeon, who, the author 
is authentically informed, during a journey by rail in which he was 
deprived of the customary facilities for hypodermic injection, ripped 
open his arm with a pocket-knife and poured the drug into the 
wound. 

In such cases the salient features of the malady may be prop- 
erly regarded as allied to those of acute mania, the treatment being 
exceedingly difficult — the more so because of the absence of deter- 
rent motives prompted by conscience, which in the course of the 
indulgence becomes torpid or perverted. There is, moreover, with 
cocaine-poisoning always danger of deliberate or involuntary relapse. 

It frequently happens that cocainism arises from a desire to 
relieve effects produced by the immoderate use of opium. Yet the 
latter drug, being taken to offset the influence of cocaine, in reality 



520 A TEXT-BOOK OF MATERIA MEDICA. 

but aggravates the evil, the two agents interacting and still further 
lessening the chances of recovery. 

Treatment of Poisoning. — Several antidotes have been favorably 
adopted — amyl nitrite, caffeine, atropine, and inhalations of ammonia. 
Chloroform, ether, subcutaneously injected, and strychnine have 
also proved more or less efficient remedies. 

With regard to the withdrawal of cocaine, equally competent 
authorities appear to differ, the immediate cessation of the drug 
being advocated, and again this course condemned as liable to 
produce collapse. The author is of the opinion that, as in other 
respects, the procedure followed in the treatment of the opium 
habit is the wisest and safest. 

The disease, however, at least during its more serious manifes- 
tations, is essentially allied to insanity, and permanent cure must 
look to the rationale of the conditions, with the paramount object 
of restoring to its normal activity the moral tone of the patient's 
thought and desire. That complete regeneration of mind and body 
may be reasonably contemplated is amply attested by the case 
above cited ; nor should discouragement deter the physician from 
his task, nor measures of untimely severity be suffered to exas- 
perate and confirm an untoward mental state possibly susceptible 
of intelligent control. 

Therapeutics. — Externally and Locally. — The indications for 
the local anesthetic action of cocaine are very numerous. The 
general surgeon will find many opportunities to employ the drug 
advantageously ; indeed, in many instances it has replaced all 
other anesthetics. In many operations on the genito-urinary tract, 
rectum, nose, throat, ear, and eye it serves a most valuable pur- 
pose. The urethra can be rendered perfectly insensible to pain by 
the application of a 2 to 4 per cent, solution, repeated two or three 
times at intervals of five or ten minutes. Even the sensibility of 
the bladder itself can be benumbed to a great extent by the local 
application of a cocaine solution, so that sounding for stone may be 
painlessly accomplished. A case of lithotrity is reported in which, 
without suffering, an operation was performed in fifteen minutes, 
the only anesthetic used being a solution of cocaine applied to the 
parts. 

Urethral caruncles may be removed successfully and without 
inconvenience to the patient by the injection of a 4 per cent, solu- 
tion at the lines of attachment. An injection of a small amount 
of the same solution into the cellular tissue of the prepuce pre- 



MOTOR EXCITANTS. 521 

vents pain in circumcision and in the operation for phimosis. In 
the treatment of fistula in ano, hemorrhoids, both internal and 
external, and other diseases of the rectum, cocaine is of signal value. 

An ointment of cocaine, 4 per cent, strength, affords a grateful 
anodyne dressing for burns, it being borne in mind that in all cases 
where ointments of this drug are used the alkaloid cocaine, and 
not its salts, is to be employed. 

Cocaine is an important anesthetic in many minor operations, 
such as opening of felons, abscesses, etc.; it is also highly service- 
able in dentistry and for the removal of small neoplasms. Prob- 
ably its most extensive use in this respect is in operations upon 
the eye, nose, and throat, its widest field of usefulness being in 
operative ophthalmic surgery. 

The following prescription makes an efficient application for 
the relief of many of the distressing symptoms of acute coryza 
and hay fever : 

B. Cocainae hydrochloratis, gr. x (0.6 Gm.); 

Menthol, gr. xij (0.72 Gm.) ; 

Pulveris camphorae, gr. iij (0.2 Gm.) ; 

Pulveris magnesiae, 

Sacchari lactis, aa. 3ij (8.0 Gm.). 

M. — Sig. Use a small portion as a snuff twice a day. 

A small quantity of morphine sulphate is sometimes an excellent 
addition to the above. 

Great care should be taken in the administration of this snuff, 
since its frequent use may easily induce the cocaine-habit. 

The peculiar qualities of cocaine render it one of the safest, as 
well as most convenient and serviceable, mydriatics. It quickly 
dilates the pupil, which regains its normal condition in from ten to 
twenty hours. The dilatation, too, is easily overcome by the 
application of eserine, a solution of J- grain (0.03 Gm.) to 1 ounce 
(30.0 Cc.) of the latter drug being strong enough to neutralize the 
effects of a 4 per cent, solution of cocaine. 

It should be remembered that local applications to the conjunc- 
tivae, nares, and fauces may produce in susceptible persons systemic 
effects. 

Cocaine combined with atropine forms a mydriatic which for 
many purposes is superior to either drug separately, the mydriasis 
being of longer duration than that produced by cocaine, while the 
paralysis of the accommodative apparatus is briefer than that 



522 A TEXT-BOOK OF MATERIA MEDICA. 

occasioned by atropine. It should be remembered that isa-tropyl 
cocaine may cause great cardiac depression. 

The phenate of cocaine is less toxic than the hydrochlorate, 
owing to its power of coagulating albumin, and thereby being less 
readily absorbed. It is also more agreeable to the taste. While it 
does not produce anesthesia so readily as the hydrochlorate, its 
effect is more permanent, and, in addition, it possesses powerful 
antiseptic properties. By many physicians it is preferred in laryn- 
gological work. 

Internally. — Coca has been successfully used in gastralgia and 
to improve the digestion. Cocaine is frequently an efficient remedy 
in sea-sickness and to allay excessive vomiting. 

Bartholow has highly recommended the drug in chorea, asthma, 
paralysis agitans, and alcoholic and se7tile tre7nor. It has also been 
suggested as a cure for the opium, alcohol, and tobacco habits. 

The wine of coca is an excellent tonic during convalescence 
from acute disease and in debilitated conditions generally. It has 
been extensively employed in melancholia. 

Cocaine combined with atropine is said to make an efficient 
hypnotic. 

Spinal Analgesia. — Within recent years the use of cocaine, 
thrown into the spinal cord, has been very wide-spread. It was 
first pointed out by Corning, of New York, a number of years ago, 
that such a procedure would induce analgesia of the lower limbs, 
but no practical use was made of this suggestion. Bier, of Kiel, 
rehabilitated the procedure, adopting the newer points of technic 
brought out by Quincke in his observations on lumbar puncture, 
and performed major operations below the umbilicus during the 
analgesia conferred by the drug. Tuffier, Murphy, Fowler, Bain- 
bridge, Reclus, and many others have supplemented the early 
observations, and at the present time there is a large literature con- 
cerning the intrarachidian injections of cocaine in surgery. Many 
operations, heretofore impossible to perform by reason of accom- 
panying cardiac or renal disease, thus making the employment of 
ether or chloroform unwise, have been done successfully under 
cocaine analgesia. In many respects an ideal has been reached, 
but there are a number of drawbacks to its use here. Headache, 
nausea, vomiting, great prostration, and weakness, accompanied by 
dizziness, have been noted with varying constancy as following the 
use of the drug in this manner. Its use, therefore, presents some 
questions of expediency that subsequent experience must answer. 



MOTOR EXCITANTS. 523 

A logical outcome of the use of cocaine in this manner in 
surgery is its use in persistent neuralgias — sciatic and others. 
These have been relieved in many instances, most often to return, 
yet at times not. The pains of tabes have also been markedly 
relieved by the same procedure. 

Time and experience alone will determine what the subsequent 
developments may be along these lines. 

Similar Products. — In coca leaves there are other cocaines 
and still others are made synthetically from the ecgonine base, but 
these have not been used to any great extent. Cocaininc, benzoyl- 
ecgonine, tropacocaine have been used sparingly. The last has 
been employed in spinal analgesia in the place of cocaine. 

Eucaine. — Alpha and beta-eucaine are newer artificial alkaloids 
used as substitutes for cocaine. They differ from cocaine in that 
they may be subjected to boiling and are not thereby decom- 
posed. Moreover, they are less toxic and have about equal 
analgesic properties. Beta-eucaine is to be preferred, as it is 
less irritating. On the eye, they do not dilate the pupils so 
widely and are capable of extensive employment in ophthalmic 
practice. 

Holocaine is a synthetic derivative from phenacetine, used 
widely in ophthalmic practice for much the same purposes. It is 
not so satisfactory in many respects. 

Orthoform — C 6 H 3 OH (NH 2 ) (COOCH 3 ) — is another product, 
of radically different chemical composition, being derived from 
benzoic acid, that possesses many of the same analgesic properties 
of cocaine. It is a white, slightly soluble powder, and is useful as a 
dusting-powder, proving antiseptic and analgesic at the same time. 
It is extensively used in the treatment of ulcers — rectal, urethral, 
laryngeal, gastric, etc. — of tuberculous, syphilitic, or carcino- 
matous origin, and offers excellent opportunities as a local anal- 
gesic, as it remains in contact for a considerable space of time 
because of its comparative insolubility. 

The following salts of cocaine have been manufactured and 
are used for much the same purposes as the hydrochloride and 
in the same dosage : Cocaine aluminium citrate, sulphate, borate, 
cantharidate, lactate, nitrate, phenate, saccharate, salicylate, and 
stearate. Cocapyrine is a mixture of cocaine and antipyrine I : 100. 

Contraindications. — No special or distinct contraindication to 
its use exists. In diseases of the kidneys with diminished urinary- 
flow it should be cautiously administered, lest cumulative effects 



524 A TEXT-BOOK OF MA TERIA MEDICA. 

ensue. With subjects suffering from weak or diseased heart similar 
caution is to be used. 

Administration. — For hypodermic use solutions of from 2 to 
5 per cent, are generally employed. 

It should be noted that children and females require smaller 
doses of the drug. 

It is altogether probable that many of the coca wines on the 
market contain varying quantities of cocaine. The reckless and 
indiscriminate prescription of these preparations, therefore, is liable 
to induce the cocaine habit. It is questionable, indeed, whether 
the administration of cocaine with a view to curing the intemperate 
use of opium, alcohol, or tobacco is wise. It frequently happens 
that patients thus treated lose their craving for the latter drugs 
only to acquire an inordinate appetite for cocaine, which, as has 
been shown, is possibly more dangerous than either of them in its 
physical and moral effects. 



GROUP VII.— MOTOR DEPRESSANTS. 
Conlum— Conli— Conium. U. S. .P. 

(Hemlock.) 

Origin. — The full-grown fruit of Conium maculatum L., gath- 
ered while yet green. Spotted hemlock is a biennial indigenous 
in the temperate regions of Asia, Europe, and Northern Africa, and 
naturalized in some portions of New England, New York, and 
South America. It grows in waste places and along streams. 

Description and Properties. — About \ inch (3 Mm.) long, 
broadly ovate, laterally compressed, grayish-green, often divided 
into two mericarps, each with five crenate ribs, without oil-tubes, 
and containing a seed grooved on the face ; odor and taste slight. 

When triturated with solution of potassium or sodium hydrate 
conium gives off a strong, disagreeable, mouse-like odor. 

The most important constituent is a volatile liquid alkaloid, 
coniine. It also contains methyl-coniine, conhydrine, and its isomer 
pseudo-conine. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Official Preparations. 

Extr&ctum Conii — Extracti Conii — Extract of Conium. — Dose, %-i grain 
(0.03-0.06 Gm.). 



MOTOR DEPRESSANTS. 525 

Extr3ctum Conii Fluidum — Extraxti Conii Fluidi— Fluid Extract of Co- 
nium. — Dose, 1-5 minims (0.06-0.3 Cc). 

Unofficial Preparations. 

Tinctura Conii — Tincturae Conii— Tincture of Conium (15 per cent.).— Dose, 
10-30 minims (0.6-1.8 Cc). 

Siiccus Conii — Siiccus Conii — Conium Juice. — Dose, \-z fluidrachms (1.8-7.4 
Cc). The juice expressed from fresh leaves, and i volume of alcohol added to pre- 
serve it. 

Conilna — Coniinae — Coniine. — Description and Properties. — A colorless, inflam- 
mable, oily liquid, having a strong alkaline reaction and a penetrating, suffocating odor. 
It is soluble in all proportions in alcohol, ether, chloroform, benzene, benzin, and fixed 
oils. It requires 100 parts of cold water for solution, the liquid becoming turbid on 
warming. 

Dose. — yo-i minim ( 0.006-0.06 Cc). 

Coniinae Hydrobrdmas — Coniinae Hydrobromatis — Coniine Hydrobro- 
mate. — Description and Properties. — It occurs in colorless, transparent prisms ; soluble 
in water and alcohol in the proportion of I to 2 parts ; very slightly soluble in ether. 

Dose. — jq-1 grain (0.002-0.06 Gm.). 



Antagonists and Incompatibles. — Nux vomica and its alka- 
loids, cocculus and picrotoxin, are antagonistic to conium. Tannic 
acid and the alkalies are chemically incompatible. 

Synergists. — The motor depressants and morphine. 

Physiological Action. — Externally and Locally. — Coniine, the 
active principle of conium, has no effect upon the unbroken skin. 
Applied to bruised surfaces, it has been thought to possess anes- 
thetic or analgesic properties. 

The specific behavior of the drug, however, renders the above 
action problematical, according to some authorities. 

Internally. — Digestive System. — Conium increases the salivary 
secretion, and when taken into the stomach exerts no special action 
upon the digestive system, other than an occasional disturbance of 
the gastro-intestinal tract, possibly resulting in vomiting and diar- 
rhea under full dosage. 

Circulatory System. — Although when ingested coniine is rapidly 
absorbed by the blood ; circulating in the system unchanged, its 
action is not clearly defined, though it has been held that the cir- 
culation is first accelerated and then retarded, with a lowering of 
arterial pressure preceded by a decided increase. 

From its capacity to paralyze the terminal vagi it is natural to 
suppose that it increases the rapidity of the cardiac movements, 
yet a characteristic feature of the absorption of coniine is the appar- 



526 A TEXT-BOOK OF MATERIA MEDICA. 

ent absence of cardiac derangement, the heart, as well as the mind, 
remaining unaffected in the presence of alarming symptoms. 

Nervous System. — The brain is unaffected, consciousness being 
preserved to the last; muscular irritability is uninfluenced; and 
even under large doses there is little impression made upon the 
nerves beyond a slight impairment of their conductivity, thus inter- 
fering with the transmission of motor impulses. This latter influ- 
ence is first manifested in the peripheries, gradually ascending until 
the spinal cord is involved, the reverse process marking the effects 
of the methyl-coniine. 

Respiratory System. — Large or poisonous doses act as depres- 
sants upon the respiratory center in the medulla, and, although the 
breathing may at first be normal, paralysis and asphyxia may finally 
result from paralysis of the nerve terminals. 

Absorption and Elimination. — The drug is readily absorbed, 
elimination taking place by various channels, but chiefly through 
the kidneys and by expiration. Coniine has been detected in con- 
siderable quantities in the liver, lungs, and spleen. 

Temperature. — It has been held that bodily temperature is per- 
ceptibly lowered by conium, proportionately with the extent of the 
paralysis occasioned. High authorities, however, assert an increase 
of temperature under both therapeutic and toxic doses. 

Eye. — Heaviness of the eyelids, dilated pupils, accompanied by 
double or confused vision and occasionally entire loss of sight, 
have been noted among the symptoms incident to the administra- 
tion of active dosage. The effects thus recorded have been ascribed 
to paralysis of the third nerve rather than to stimulation of the 
sympathetic. 

Poisoning. — A frequent symptom of conium-poisoning is ptosis, 
arising from paralysis of the oculo-motor nerves. Staggering gait, 
general muscular relaxation, impairment of vision, nausea, and ver- 
tigo are also not infrequent. The severer symptoms are marked 
by muscular paralysis of the extremities, derangement of vocal 
organs resulting in difficulty of speech, and dilatation of the pupils. 
The brain meanwhile remains unaffected until overcome by the 
accumulation of carbonic-acid gas in the blood, when delirium and 
coma may ensue, and finally cerebral convulsions and fatal collapse 
through respiratory failure. 

With regard to the effect of toxic doses upon the heart conflict- 
ing statements are recorded, experiment having proved that in 
warm-blooded animals the cardiac movements speedily cease, it 



MOTOR DEPRESSANTS. 527 

being authoritatively stated, on the other hand, that the drug exerts 
no influence upon the heart. 

Treatment of Poisoning. — The stomach should be evacuated by- 
means of emetics or lavage, after which tannic acid and the phys- 
iological antidotes may be administered — tetanizing agents, such 
as strychnine and picrotoxin, with alcoholic stimuli if necessary. 
Coffee and also hypodermic injections of atropine have been 
highly recommended. Muscular exercise has been known to delay 
the action of the poison, and free counter-irritation by mustard 
may be serviceable. 

Therapeutics. — Externally and Locally. — In many respects 
the medicinal operation of conium bears no relation to its physio- 
logical action. Experimentation shows that it exerts but a feeble 
action upon the sensory nerves, yet clinical experience establishes 
its value in mitigating the pain of cancer when locally applied. In 
ulcerating cancer of the breast especially, poultices composed of 
conium leaves afford wonderful relief from pain and greatly 
improve the condition. A similar application has proved beneficial 
in scrofulous glandular sores. Dewees has recommended an injec- 
tion composed of the extract 3 parts to water 16 parts in uterine 
cancer. 

It is quite problematic whether conium has any well-marked 
therapeutic applications. If it is employed, it is absolutely essen- 
tial that a very fresh specimen be employed, since the active alka- 
loid is volatile. It is perhaps best to use a salt of the alkaloid or a 
salt of methyl-conine. 

Reports of the value of this drug in ovarian menorrhagia, locally 
applied, in acute laryngitis, in the cough of phthisis, and in acute 
bronchitis, as vapor, are found in literature. It has also been 
recommended on empirical grounds in acute mania, chorea, asthma, 
paralysis agitans, tetanus, hydrophobia, epilepsy, puerperal eclamp- 
sia, but hopes should not be built on its efficacy. 

It is distinctly useful at times in habit spasms and tics of various 
kinds, and sometimes in torticollis. 

Contraindications. — Conium should not be given to persons 
suffering from great exhaustion and debility or from diseases inter- 
fering with the rhythm of the heart. 

Administration. — The preparations of conium are very unreli- 
able, the assayed, or " standardized " fluid extract being perhaps the 
one to be depended upon most uniformly. Owing to the uncer- 
tainty of their strength, the administration should begin with small 



528 A TEXT-BOOK OF MA TERIA MEDICA. 

doses gradually augmented until interference with involuntary- 
motion is observed, when further increase should be stopped. 

The effects of the drug are weakened by repeated doses, 
rendering an increase in the dose necessary from time to time. 
Coniine and morphine greatly aid each other, and this combination 
is a particularly efficient one in the treatment of painful muscular 
spasms and acute mania with excessive motor activity. Conium 
and sulphonal are of great value in insomnia accompanied by motor 
restlessness. 

Dr. Squibb has stated that there is danger in diluting the fluid 
extract, a precipitate being formed containing the active principle. 

Curare— Curare— Curare. 

(WOORARI.) 

Origin. — An extract of uncertain composition prepared by the 
natives of South America as an arrow-poison. Dr. Jobert reported 
to the French Academy in 1878 that the poison was prepared 
chiefly from Strychnos Castelnceana and other species of Strycknos, 
and Cocculus toxiferus, containing also variable quantities of other 
poisonous plants, such as Didelphys cancrivora, etc. It is alto- 
gether probable that its ingredients include the poison of venomous 
reptiles. 

Description and Properties. — The extract is a blackish-brown, 
friable solid, brittle or hygroscopic, of a very bitter taste ; almost 
completely soluble in dilute alcohol. Cold water dissolves about 
75 per cent., which portion contains the poisonous alkaloids and is 
insoluble in ether and but sparingly soluble in absolute alcohol. 

Two alkaloids have been obtained from this substance — curarine 
and curine. 

Dose. — 2*0 " I grain (0.003-0.03 Gm.), hypodermically given. 

Dose of Curarine. — giro-Tiro g ram (0.0003-0.0006 Gm.), hypo- 
dermically. 

Antagonists and Incompatibles. — The excito-motors are an- 
tagonistic. Tannic acid and the caustic alkalies are chemically 
incompatible. 

Synergists. — The depresso-motors. 

Physiological Action. — When applied to the denuded skin it is 
a powerful irritant ; introduced into the circulation hypodermically, 
it exerts a very decided and characteristic action. 

Circulatory System. — Medicinal doses render the pulse fuller 
and exceedingly rapid ; there is marked • dilatation of the blood- 



MOTOR DEPRESSANTS. 529 

vessels of the skin and the various glands ; while the blood-pres- 
sure, though little affected by small doses, is decidedly lowered by 
large ones. The action on the circulation is due to diminished 
inhibition on the heart, owing to paralysis of the ends of the vagi, 
while the accelerator nerves are stimulated. 

Nervous Sy stern. — Immoderate doses cause great muscular 
weakness and paralysis of all the voluntary muscles. The ends 
of the motor and sensory nerves are paralyzed, the former being 
soonest affected. Beyond a slightly diminished contractility the 
voluntary muscles are but little influenced. The spinal cord may 
be paralyzed under toxic doses, although the brain-centers remain 
unaffected until carbonic-acid narcosis sets in. 

Respiratory System. — Curare is a powerful respiratory depress- 
ant, paralyzing the ends of the motor nerves distributed to the 
respiratory muscles. When lethal doses have been given the 
paralysis becomes central, finally producing death by its action on 
the respiratory muscles. 

Absorption and Elimination. — When ingested the process of 
absorption is exceedingly slow, but when injected into the circula- 
tion the drug is rapidly absorbed. 

It is quickly eliminated by the kidneys, causing sugar to appear 
in the urine. A portion of the poison is also excreted with the 
feces. The sweat, saliva, nasal mucus, and tears, although their 
secretion is greatly increased by the drug, do not seem to share in 
the process of elimination. 

Temperature. — The temperature is elevated. 

Eye. — Under poisonous doses there is marked ptosis, disordered 
vision, protrusion of the eyeballs, and, as a late ocular symptom, 
myosis. 

Poisoning. — Curare is a rapid and active poison. The move- 
ments of the heart are greatly accelerated ; the pulse is weak and 
dicrotic ; the temperature is elevated, and the respiration corre- 
spondingly depressed ; extreme muscular weakness ensues, with 
incoordination of movements ; the urine becomes saccharine. 
Finally, paralysis of the extremities and the respiratory muscles 
supervenes, death occurring from respiratory paralysis. 

Treatment of Poisoning. — The same as in the treatment of poi- 
soning from conium, with catheterization of the bladder to favor 
elimination, and artificial respiration. 

Therapeutics. — While of great scientific interest and of value 
for experimental purposes in ascertaining the effect of certain drugs 
34 



% S30 A TEXT-BOOK OF MATERIA MEDICA. 

upon animals, the therapeutic uses of curare are quite limited, being 
confined to certain spasmodic diseases, particularly hydrophobia. The 
remedy has also been used with varying success in chorea, tetanus, 
and epilepsy, but when the convulsions are due to excessive activity 
of the cerebral motor areas the bromides are superior to curare. 

Contraindications. — The same as for conium. 

Administration. — The crude drug or the alkaloid curare should 
be given hypodermically. 

Gelsemium— Gelsemii— Gelsemium. IT. S. I*. 

(Yellow Jasmine.) 

Origin. — The rhizome and roots of Gelsemium sempervirens (L.) 
Pers., a plant indigenous in the southern United States, growing in 
moist woods. 

Description and Properties. — Cylindrical, long or cut in sec- 
tions about I inch (25 Mm.) in length, externally light yellowish- 
brown, with purplish-brown longitudinal lines ; tough, fracture 
splintery ; bark thin, with silky bast-fibers closely adhering to the 
pale-yellowish, porous wood, which has five medullary rays, and 
in the rhizome a thin pith ; odor aromatic, heavy ; taste bitter. 

It contains two alkaloids, gelsimine, which has an action closely 
resembling strychnine, and gelsiminine ; which acts more like coniine. 
The general effects are therefore blended, but gelseminine is the 
more potent alkaloid, for man at least. 

Dose. — 2-10 grains (0.13-0.6 Gm.). 

Official Preparations. 

Extractum Gelsemii Fluidum— Extracti Gelsemii Fluidi— Fluid Extract 
of Gelsemium. — Dose, 2-10 minims (0.12-0.6 Cc). 

Tinctura Gelsemii — Tincturae Gelsemii — Tincture of Gelsemium. — Dose, 
15-60 minims (1.0-4.0 Cc). 

Gelsemlna (unofficial) — Gelseminae — Gelsemine. — Description and Proper- 
ties. A brittle solid, transparent, crystallizable mass, converted into a colorless liquid at 

45 C. (113 F.). Insoluble in cold water, but soluble to a slight extent in hot water, 
as well as in alcohol; taste bitter. 

Dose.— 2^0-^0 § rain (0.0003-0.001 Gm.). 

Antagonists and Incompatibles. — The cardiac and diffusible 
stimulants are antagonistic; tannic acid and caustic alkalies are 
incompatible, precipitating the alkaloid. 

Synergists. — The motor depressants. 

Physiological Action. — Externally and Locally. — It is a mild 
sedative and astringent, the alkaloid being a mydriatic. 

Internally. — Digestive System. — No special action has been 



MOTOR DEPRESSANTS. 



531 



noted, though when excessive doses have been taken nausea and 
vomiting may ensue. 

Circulatory System. — Medicinal doses of gelsemium produce no 
marked effect, but toxic doses reduce the heart's action, rendering 
the pulse slower and weaker and lowering arterial tension. 

Nervous System. — The drug has no effect upon higher cerebral 
centers, the mind remaining clear to the last. In large doses it 
paralyzes the roots of the motor cerebral nerves and the motor 
areas of the spinal cord, with consequent paralysis of all the mus- 
cles of the body, and, according to some authorities, terminal nerve 
filaments are paralyzed. This condition is succeeded by cutaneous 
anesthesia, due to depression of the receiving center and the sen- 
sory tract in the spinal cord. The motor nerves and muscles are 
unaffected. Convulsions rarely result in man from a poisonous 
dose, but occur in animals, with backward movements. The exact 
cause of this action is undetermined. 

Respiratory System. — The breathing is rendered slower and 
shallower, being frequently irregular. Death results from asphyxia, 
caused by depression and ultimate paralysis of the respiratory center. 

Absorption and Elimination. — Gelsemium is speedily absorbed 
and readily excreted, chiefly by means of the kidneys. Untoward 
symptoms produced by immoderate amounts of the drug prac- 
tically subside within three hours after ingestion. 





Fig. 8.— Diagram showing how gelsemium produces convergent strabismus : A, A, superior rectus ; 
B,B, external rectus— too weak; C,C, internal rectus; D,D, third nerve; E,E, sixth nerve; F,F, 
optic nerve; G,G, lesser wing. 



Temperature. — Poisonous doses cause a reduction in temper- 
ature. 

Eye. — Under full dosage the pupil is widely dilated and diplopia 
and marked ptosis ensue. The mydriasis and ptosis are caused by 



532 A TEXT-BOOK OF MATERIA MEDICA. 

paralysis of the third nerve. The sixth, which innervates the ex- 
ternal rectus muscle, is often depressed more than the third nerve, 
supplying the internal rectus, producing convergent strabismus, as 
shown in Figure 8. 

The diplopia is caused by the squint and incoordination of the 
ocular movements. In strabismus the eyes are" not directed exactly 
to the object, and the image does not fall on corresponding parts 
of the retinae ; consequently, two perceptions are received in the 
visual center and two objects apparently seen. 

Uterus. — No important action has been observed. 

Untoward Action. — This does not essentially differ from that 
observed in poisoning, though the symptoms may be of a milder 
form. 

Poisoning. — In toxic doses gelsemium is quickly fatal. The 
early symptoms include drooping of the eyelids, wide dilatation 
and immobility of the pupils, extreme muscular weakness, affecting 
first the muscles of the upper extremities, and incoordination of 
movements. Diplopia and dimness of vision may ensue, accom- 
panied by difficulty of speech, coldness of the body surface, and 
general cutaneous anesthesia, with decidedly lower temperature. 
Meanwhile, there is marked diminution in the force and frequency 
of the pulse and respiration. 

While the patient may be drowsy, the mind is unaffected until 
carbonic-acid narcosis supervenes. Death is usually the result of 
respiratory failure, due to paralysis of the muscles of respiration. 
Paralysis of the heart also occurs. (See Plate I.) 

Treatment of Poisoning. — The evacuation of the stomach is of 
the first importance, either by the stomach-pump or by the use of 
emetics. Washing out with a solution of tannic acid is probably 
the best method to pursue. External heat should be applied and 
diffusible stimulants administered, followed by digitalis and strych- 
nine. The hypodermic injection of morphine and atropine is 
highly recommended in gelsemium-poisoning. 

Therapeutics. — Externally and Locally. — The drug is seldom 
used externally, although it has been employed by ophthalmolo- 
gists as a mydriatic. 

Internally. — Clinically, gelsemium is now considered less valu- 
able than formerly. It has been favorably mentioned by certain 
authors in the treatment of tetanus, mania with motor excitement, 
and paralysis agitans. Theoretically, it would seem to be of value 
in certain convulsive disorders, like chorea, pertussis, etc., yet its 



PLATE II 





Gelsemi 



um-poisonmg. 



MOTOR DEPRESSANTS. 533 

use has not met with the success which its action upon the mus- 
cular system would indicate. 

The drug appears to be more serviceable in trifacial neuralgia, 
and it seems to be even more efficient in neuralgia with involve- 
ment of the inferior dental nerve. In these disorders, as in ovarian 
neuralgia, dysme?iorrhea, etc., for which it has been employed with 
some success, the drug should be pushed to its physiological limit. 

Bartholow praised the action of gelsemium in cerebrospinal 
meningitis and "acute inflammations of the lungs and pleura!' 

Bulkley is responsible for its use in pruritus and eczema, the 
itching of which it certainly appears to alleviate. 

The therapeutics of gelsemium would perhaps be incomplete 
without mentioning hemoptysis, remittent fever, acute coryza, mi- 
graine, Meniere's disease, and spermatorrhea, in all of which the 
drug has been used and recommended. 

Contraindications. — Diseases accompanied by exhaustion and 
great muscular weakness. 

Administration. — Any of the preparations may be given, the 
initial dose being small, and the amount increased gradually until 
dilatation of the pupil or drooping of the eyelids is manifest. 

Grindelia— Grindeliae— Grindelia. U. S. P. 

Origin. — The leaves and flowering tops of Grindelia robusta 
Nutt, and of Grindelia squarrosa Dunal, herbaceous or suffruticose 
perennials indigenous in the western part of North America and 
Mexico. 

Description and Properties. — Leaves about 2 inches (5 Cm.) 
long, varying from broadly spatulate or oblong to lanceolate, sessile 
or clasping, obtuse, more or less sharply serrate, often spinous- 
toothed or even laciniate-pinnatifid, pale-green, smooth, finely 
dotted, thickish, brittle ; heads many-flowered, subglobular or 
somewhat conical, the involucre hemispherical, about ■§ inch 
(10 Mm.) broad, composed of numerous imbricated, squarrose- 
tipped, or spreading scales ; ray-florets yellow, liqulate, pistillate ; 
disk-florets yellow, tubular, perfect ; pappus consisting of two or 
three awns of the length of the disk-florets ; odor balsamic ; taste 
pungently aromatic and bitter. 

The principal constituent is probably a resinous substance. It 
also contains an alkaloid principle, grindeline, and a volatile and a 
fixed oil. 

Dose. — 10-60 grains (0.6-4.0 Gm.). 



534 A TEXT-BOOK OF MA TERIA MEDICA. 

Official Preparation. 

Extr&ctum Grindeliae Fluidum — Extr&cti Grindeliae Fluidi — Fluid Extract 
of Grindelia. — Dose, 10-60 minims (0.6-3.7 Cc). 

Antagonists and Incompatibles. — The motor excitants and 
cerebral stimulants are antagonistic. Aqueous preparations, the 
caustic alkalies, and mineral salts are incompatible. 

Synergists. — The motor depressants. 

Physiological Action. — Externally and Locally. — The drug is 
sedative and mildly astringent. 

Internally. — Digestive System. — When ingested it excites a sense 
of warmth in the epigastrium, and in moderate doses increases the 
secretion of the gastric juice, stimulating the appetite and improv- 
ing digestion. 

Circulatory System. — It differs somewhat from conium in that 
the heart is slowed by medicinal doses through stimulation of the 
inhibitory center. The blood-pressure, however, is raised and 
maintained by stimulation of the vaso-motor center. 

Nervous System. — Grindelia possesses considerable hypnotic 
power. Its effect upon the motor mechanism is similar to that of 
conium, the muscular weakness affecting first the lower extremi- 
ties. The sensory nerves are first depressed, there being quite 
marked cutaneous anesthesia. The drug depresses the reflex 
mechanism in the spinal cord, so that the reflex movements are 
greatly lessened : it is said that it also depresses the phrenic nerve. 

Respiratory System. — Small doses have little effect upon the 
respiratory movements ; large doses retard the breathing ; while 
toxic doses may produce death through paralysis of the respiratory 
muscles. 

The drug slightly increases the secretion from the pulmonary 
mucous membrane, and relaxes the circular fibers of the bronchial 
muscles through depression of the ends of the motor fibers of the 
vagus distributed to these muscles and of the reflex center in the 
medulla. The ends of the sensory nerves distributed to the pul- 
monary mucous membrane are also depressed. 

Absorption and Elimination. — Grindelia is readily absorbed, and 
is eliminated chiefly by the kidneys, increasing the urinary flow, 
the lungs sharing in the excretory process. 

Temperature is unaffected. 

Eye. — Large doses cause dilatation of the pupil. 

Uterus. — No effect has been noticed. 

Untoward Action. — Excepting drowsiness, reduction of cutane- 



MOTOR DEPRESSANTS. 



535 




ous sensibility, slight gastric disturbance, and a feeling of weakness 
no symptoms have been recorded. 

Poisoning. — The drug is feebly toxic; excessive doses, how- 
ever, act as a gastro-intestinal irritant. The patient is sleepy and 
complains of muscular weakness ; there 
is a numb or anesthetic condition of the ' 
skin, while the pupils are dilated and 
the pulse and respiratory movements 
slow and feeble. Should death occur, 
it will be from paralysis of the muscles 
of respiration. 

Treatment of Poisoning. — The same 
as in poisoning from conium — diffusible 
stimulants, strychnine, etc. 

Therapeutics. — Externally and Lo- 
cally. — Grindelia is a very efficient ap- 
plication to the skin in rhus-poisoning. 
Indeed, it serves as a soothing lotion in 
many acute inflammations of the skin, 
such as eczema, etc. The fluid extract fig. 9 .-Dia g ram showing how grin- 
used should be well diluted and applied delia relaxes s P asm of the bronchi *i 

muscles in asthma. The sensory nerves 
On ClOtnS. (B) in the mucous membrane of the 

Indolent ulcers are well treated by a bronchial , tubes -depressed,™ that 

J there is less irritation transmitted to 

diluted Solution Of the drug. It also the medulla, to be returned by the 

ctl • l • • j.' ' motor fibers supplying the bronchial 

serves as an efficient injection in gonor- muscles , thusexc P itin y gl T ronchialspasm . 

rhea, leUCOrrhea, and Vaginitis. The respiratory center {A) is depressed, 

T j 7 /-« • i i« 1 i together with the ends of the motor 

Internally.— Grindelia has acquired nerves {C)> limiting the amount of irri . 
an enviable reputation as a remedy for tation in the bronchial muscles (E). 

. The diaphragm (F) is relaxed through 

Spasmodic aSthma, ltS aCtlOn Upon the depression of the phrenic nerve (D). 

bronchial muscles rendering it singu- 
larly beneficial in this disorder. It acts upon every possible point 
to relax the spasm of the bronchial muscles, as is shown in Fig- 
ure 9. The drug has no influence, however, in preventing a recur- 
rence of the paroxysms. 

The drug has been highly recommended in acute and chronic 
bronchitis, hay fever, whooping cough, and in spasmodic cough of 
whatever nature. It has even been suggested as a palliative remedy 
in pneumonia and cardiac and pulmonary dyspnea. 

There are no special Contraindications or directions for Ad- 
ministration, save that the fluid extract is pharmaceutically incom- 
patible with aqueous preparations. 



53 6 A TEXT- BOOK OF MATERIA MEDIC A. 

Physostigma— Physostigmatis— Physostigma. 

IT. S. I>. 

(Calabar Bean.) 

Origin. — The seed of Physostigma venenosum Balfour, a lofty, 
half-shrubby, climbing plant (somewhat resembling the scarlet- 
runner or Spanish bean of our gardens) growing near the mouths 
of the Niger and Old Calabar River in Western Africa, and attain- 
ing a height of 40 or 50 feet (12-15 M.). 

Description and Properties. — The seeds are about I to ij 
inches (25-30 Mm.) long, f to f inch (15-20 Mm.) broad, and J- to 
finch (10-15 Mm.) thick; oblong and somewhat reniform ; testa 
granular, chocolate-brown, with a broad black groove extending 
the entire length of the convex edge ; embryo with a short, curved 
radicle and two large, white concavo-convex cotyledons ; inodor- 
ous ; taste bean-like. 

The drug contains an alkaloid, physostigmine (also known as 
eserine), which is the principal constituent ; calabarine, to which the 
drug owes its tetanizing properties ; and eseridine (a laxative and 
motor excitant) ; besides a neutral principle, physosterin, related to 
cholesterin. 

Dose. — 1-4 grains (0.065-0.25 Gm.). 

Official Preparations. 

Extralctum Physostigmatis — Extralcti Physostigmatis — Extract of Physo- 
stigma. — Dose, y^—g- grain (0.004-0.01 Gm.). 

Tinctura Physostigmatis — Tincturae Physostigmatis — Tincture of Physo- 
stigma. — Dose, 5-10 minims (0.3-0.6 Cc). 

The alkaloid, Physostigmine, is not official. It occurs in colorless or slightly pink- 
ish crystals ; sparingly soluble in water ; readily soluble in alcohol. — Dose, jfo-^o S ram 
(0.0006-0.003 Gm.). The salicylate and sulphate of physostigmine are official. 

Physostigminae Salicylas — Physostigminae Salicylatis — Physostigmine 
Salicylate (Eserine Salicylate). U. S. P. 

Description and Properties. — Colorless or faintly yellowish, shining, acicular, or 
short, columnar crystals, odorless, and of a bitter taste ; acquiring a reddish tint when 
exposed to light and air; soluble in 150 parts of water and 12 parts of alcohol. The 
salicylate should be kept in small, dark amber-colored, and well-stoppered vials. 

Dose. — ^.i^-^ grain (0.0005-0.002 Gm.). 

Physostigminae Sulphas— Physostigminae Sulphatis — Physostigmine Sul- 
phate (Eserine Sulphate). U. S. P. 

Description and Properties. — A white, or yellowish-white, micro-crystalline pow- 
der, odorless, and of a bitter taste. It is veiy deliquescent when exposed to moist air, 
gradually turning reddish in air and light. Very soluble in water and alcohol ; still 
more so at the boiling-point of these liquids. It should be kept in small, dark amber- 
colored, and well-stoppered vials. 

Dose. — t1 o~3TT g ram (0.0005-0.002 Gm.). 



MOTOR DEPRESSANTS. 



Unofficial Preparation. 



537 



Physostigmlnae Hydrobromas — Physostigminae Hydrobromatis — Physo- 
stigmine Hydrobromate. — Dose, j|q - ^ grain (0.0005-0.002 Gm.). 

Antagonists and Incompatibles. — The action of physostigma 
upon the heart, respiration, and pupils is antagonized by atropine ; 
that on the spinal cord by chloral ; while, in a general way, the 
motor excitants, particularly the tetanizing agents, are therapeuti- 
cally antagonistic. 

The caustic alkalies and tannic acid are chemically incompatible. 

Synergists. — The motor depressants. 

Physiological Action. — Externally and Locally. — No external 




Fig. 10.— Diagram illustrating the mechanism of secretion. An impression is transmitted over the 
afferent nerve (2?) to the medulla (A), and thence over the secretory nerve (C) to the secretory cells 
(K, K) of the gland (F). At the same time the vaso-motor nerves (E) are stimulated, causing a con- 
traction of the arterioles (7) supplying the gland ; hence, as soon as the lymph in the lymph-spaces 
{H) is consumed, the secretion from the gland is diminished for lack of material necessary to the 
secretory cells in elaborating their normal secretions. 



action of physostigma and its preparations is noted, unless it be its 
effect upon the pupil, which outward application contracts, and the 
slight abolition of functional activity in the motor and sensory 



538 A TEXT-BOOK OF MA TERIA MEDICA. 

nerves, occasioned, it is said, by a strong solution of physostig- 
mine. 

Internally. — Digestive System. — The administration of the drug 
tends to stimulate the salivary, gastric, and intestinal secretions, 
followed by lessened secretion (see Figure 10), and, by acting 
upon the muscular coats of the stomach and intestines, to increase 
peristalsis. Nausea, retching, vomiting, and purging may result. 
The rationale of its action is doubtless direct stimulation of the 
unstriped muscle-fibers. 

Circulatory System. — No influence on the blood has been de- 
tected. Small doses increase arterial tension, the heart's action 
becoming slower and stronger. 

Although the effect upon the heart is somewhat obscure, it 
appears that under poisonous doses the cardiac pulsations are 
greatly reduced, being slow and feeble, and finally ceasing alto- 
gether. It is reasonably supposed that this action is due to pri- 
mary stimulation of the peripheral vagi, influencing the cardiac 
ganglia, and also to the effect upon the vaso-motor centers. The 
subsequent exhaustion and relaxation of the arteries are doubtless 
the result of a similar influence. 

There is marked elevation of blood-pressure under moderate 
doses, although there may occur a brief period of depression. 
Toxic doses are accompanied by a notable decrease of arterial ten- 
sion, the cardiac ganglia being seized with paralysis and the heart 
finally arrested in diastole. 

Nervous System. — As with conium, the mind is comparatively 
unaffected by physostigma, remaining lucid even to the verge of 
final collapse. The spinal cord, however, appears to bear the prin- 
cipal shock, the total abolition of reflex activity indicating a selective 
action of the drug. 

To the effect on the motor nerves, occasioning a diminution of 
power, must be attributed the muscular debility and paralytic 
symptoms manifest under the administration of toxic doses. 

Respiratory System. — No interference with respiration is caused 
by moderate doses of the drug. Larger amounts primarily de- 
press the respiratory centers, stimulate the peripheries of the pul- 
monary vagi, and contract the caliber of the bronchial tubes, even 
to the extent of serious constriction, death usually resulting from 
asphyxia. 

The breathing is first quickened and then retarded, the effect of 
the drug upon the respiration being more powerful than its circu- 



MOTOR DEPRESSANTS. 539 

latory influence, the heart continuing to beat for some time after 
pulmonary action has ceased. 

Absorption and Elimination. — The active principles of physo- 
stigma and its alkaloids are rapidly diffused in the blood. They are 
largely excreted by the kidneys, the bile and saliva contributing to 
the process of elimination, and have been detected in the gastric 
juices after intravenous injection. 

Temperature. — A slight depression has been noted. 

Eye. — Applied locally to the conjunctiva or introduced into the 
circulation, whether by ingestion or injection, physostigmine causes 
myosis or contraction of the pupil by stimulating the peripheral 
endings of the oculo-motor nerves, possibly by a depression of the 
sympathetic fibers. 

Other prominent symptoms present are spasm of accommoda- 
tion and decreased intraocular tension and myopia. Irritation of 
the third nerve is the principal cause of these phenomena : they 
have also been attributed to the stimulating action of the drug 
upon the muscular fibers of the iris rather than to any paralyzing 
influence upon the sympathetic, pupillar dilatation being manifest 
under excitation of the latter nerve. 

The intraocular pressure is lowered (i) by lessening the blood- 
supply to the eye through contraction of the blood-vessels ; (2) by 
diminishing the secretion of the aqueous humor from the glands on 
the surface of the ciliary body ; (3) by contracting the iris, so that 
the aqueous humor can more readily pass through the canal of 
Schlemm. 

Uterus. — The full influence of the drug tends to produce uterine 
contraction. 

Untoward Action. — When eserine is applied to the eye it occa- 
sionally produces a nervous contractile pain in the entire eyeball, 
which extends in a manner similar to ciliary neurosis along the 
course of the supraorbital nerve, resembling migraine. 

Small doses have in some individuals produced nausea and 
general uneasiness, and occasionally intense pain in the epigas- 
trium. 

Poisoning. — Taken in poisonous doses, physostigma causes 
nausea, giddiness, and muscular tremors and weakness, followed 
by complete muscular relaxation. Cardiac action is diminished ; 
the reflexes are in abeyance ; the respiration is retarded ; and 
myosis and motor paralysis are manifest. The pupils visibly con- 
tract, and purging and vomiting may ensue. Fatal results are 



54-0 A TEXT-BOOK OF MATERIA MEDICA. 

possible through paralysis of the respiratory center and consequent 
asphyxia. The more rapid collapse succeeding the administration 
of lethal doses is due to cardiac syncope. 

Treatment of Poisoning. — The stomach should be evacuated, the 
process being followed by the hypodermic injection of a solution 
of atropine, which may prove an efficient physiological antidote. 
Tannic acid may be used as a chemical antagonist. Diffusible 
stimulants, such as ether or ammonia, may serve t6 arrest cardiac 
and respiratory failure. Digitalis and alcohol have also been suc- 
cessfully employed. Temperature should be maintained by the 
application of external heat. 

Therapeutics. — Externally and Locally. — Physostigmine and 
eserine sulphate are the preparations usually employed, their only 
action of importance being in diseases of the eye. They are of 
value in breaking up adhesions of the iris to the cornea or lens, 
strengthening the muscle of accommodation, reducing intraocular 
pressure, and removing the effects of atropine, although Jessup 
claims that complete ciliary paralysis by atropine and the mydriasis 
induced by hyoscine are unaffected by eserine. 

In certain cases of ulcer of the cornea uncomplicated with iritis 
and sloughing keratitis, where there is little inflammation or ciliary 
irritation, eserine sometimes produces prompt improvement when 
atropine has failed. 

Paralytic mydriasis and paralysis of accommodation are tempo- 
rarily relieved by this drug, and weak solutions have been employed 
with varying success in accommodative asthenopia without refrac- 
tive errors. 

The remedy is of unquestioned value in the early stages of 
glaucoma, but only at the commencement of an acute attack and 
contraindicated in the hemorrhagic form. If the drug fails to con- 
tract the pupil when used for glaucoma, it may induce irritating 
spasm of the ciliary muscles by increasing the blood-supply to the 
iris. 

Physostigmine is sometimes employed to prevent prolapsus of 
the iris, following peripheral perforation of the cornea or cataract 
extraction, particularly without iridectomy. 

The remedy serves a useful purpose also in coal-miners' nys- 
tagmus, one drop of a collyrium containing \ grain (0.096 Gm.) of 
physostigmine sulphate in I ounce (30.0 Cc.) of distilled water 
being dropped into the eye three times a day. Eserine is also em- 
ployed in netiralgia of the eyeball and photophobia. 



MOTOR DEPRESSANTS. 541 

Internally. — Physostigma has proved efficacious in constipation 
due to an atonic condition of the intestines with deficient secretion. 
The state of the muscular intestinal layer frequently allows gas to 
accumulate in the bowels, with consequent troublesome flatulence. 
The drug, by imparting tone to the muscles and increasing peri- 
stalsis, greatly relieves this unpleasant condition. 

Gastric and intestinal dilatation have been successfully treated 
by Hare with this remedy. It is valuable in chronic bronchitis with 
dilatation of the bronchial tubes, and is said to relieve bronchial 
as t J una and emphysema. 

It has been recommended in tetanus and in general spasmodic 
disorders, but it is of questionable value in these. 

Contraindications. — The same as for conium. 

Administration. — The extract or the tincture is usually pre- 
ferred for internal administration, although the alkaloid fully repre- 
sents the drug and may be given either by the mouth or hypo- 
dermically. For application to the eye the salts of the alkaloid 
are used. A convenient form of eserine in ophthalmic practice is 
the medicated gelatin disks. 

Aspidosperma— Aspidospermatis— Aspidosperma. 

U. S. I>. 

Origin. — The bark of Aspidosperma Quebracho-bianco Schlech- 
tendal, a large evergreen tree, of exceedingly hard wood (Sp. 
quebrar, to break, and hacha, an axe), indigenous in the Argentine 
Republic. 

Description and Properties. — Occurring in nearly flat pieces 
about % to \\ inches (12.0-30.0 Mm.) thick ; the outer surface yel- 
lowish-gray or brownish, deeply fissured, inner surface yellowish- 
brown or reddish-brown, distinctly striate ; fracture displaying two 
sharply-defined strata of about equal thickness, both marked with 
numerous whitish dots and striae arranged in tangential lines ; the 
fracture of the outer lighter-colored layer rather coarsely granu- 
lar, and that of the darker-colored inner layer short-splintery; 
inodorous ; taste very bitter and slightly aromatic. 

Six alkaloids have thus far been isolated from aspidosperma, the 
most important being aspidosp ermine and quebrachine, the former 
occurring in colorless prismatic crystals insoluble in water and 
soluble in 48 parts of alcohol. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 



542 A TEXT-BOOK OF MA TERIA MEDICA. 

Official Preparations. 

Extr^ctum Aspidospfcrmatis Fluidum — ExtrScti AspidospSrmatis Fluidi — 
Fluid Extract of Aspidosperma. — Dose, 5-30 minims (0.3-1.8 Cc). 
Aspidospermine (unofficial). — Dose, \-^ grain (0.016-0.03 Gm.). 
Quebrachine (unofficial). — Dose, 1-2 grains (0.06-0.12 Gm.). 

Physiological Action. — Externally and Locally. — No important 
action has been noted. 

Internally. — Digestive System. — It is a stomachic, having an 
action analogous to the vegetable bitters. 

Circulatory System. — Aspidosperma depresses the heart, render- 
ing its action slower, with reduction of arterial tension. 

Nervous System. — In its action it resembles conium. It de- 
presses the motor mechanism by its influence on the motor centers, 
and lessens the reflexes through its influence on the spinal cord. 
Excessive doses cause vertigo and headache, together with paraly- 
sis of the extremities, the lower being first affected. 

Respiratory System. — Medicinal amounts of aspidosperma retard 
the breathing, but deepen the inspirations ; aspidospermine, on the 
contrary, increases the respiratory movements. Toxic doses para- 
lyze the respiratory center, death resulting apparently from asphyxia 
and convulsions. 

Absorption and Elimination. — It readily passes into the blood, 
and is excreted chiefly by the urine, the saliva and sweat sharing 
in the process of elimination. 

Temperature. — It is antipyretic, febrile temperature being re- 
duced by full doses of the drug. 

Poisoning. — Aspidospermine is an active respiratory poison, the 
toxic symptoms being vertigo, headache, free diaphoresis and sali- 
vation, great muscular weakness, with paralysis of the lower 
extremities, slow and weak heart, reduction of temperature, marked 
depression of the respiration, and death from respiratory failure. 

Treatment of Poisoning. — The same procedure is advisable as in 
cases of poisoning from the other motor depressants. 

Therapeutics. — Aspidosperma is not employed locally, its chief 
value being in the treatment of dyspnea of whatever variety, though 
it is fair to state that Pluzoldt considers it contraindicated in cardiac 
dyspnea. 

The drug is equal, if not superior, to grindelia in the treatment 
of spasmodic disorders of the respiratory apparatus. 

By some clinicians it is claimed to be an efficient remedy in 
pneumonia, being especially useful in relieving cyanosis. 



MOTOR DEPRESSANTS. 543 

Aspidospermine has been highly recommended as an anti- 
periodic in malaria, and has appeared to modify the symptoms of 
acute articular rheumatism. 

Administration. — Both the fluid extract and the alkaloid may 
be given internally, although a favorite and efficient method of 
administering the alkaloids is by hypodermic injection. 

Sumbul— Sumbul— Sumbul. 77. 8. P. 

Origin. — The root of Ferula sumbul (Kauffmann) Hooker fil, a 
perennial about 8 feet (2.4 M.) high, indigenous in regions north 
and east of British India. 

Description and Properties. — It occurs in transverse segments, 
varying in diameter from 1 to 3 inches (2-7 Cm.), and in length 
from 6 to 12 inches (14-30 Cm.); light spongy, annulate or longi- 
tudinally wrinkled ; bark thin, brown, more or less bristly fibrous ; 
the interior whitish, with numerous brownish-yellow resin-dots and 
irregular, easily separated fibers ; odor strong, musk-like ; taste 
bitter and balsamic. It contains sumbulic and valerianic acids, a 
small quantity of volatile oil, and two balsamic resins to which its 
odor is due. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

Official Preparation. 

Tinctura Stimbul — Tincturae Stimbul — Tincture of Sumbul. — Dose, 15-60 
minims (1.0-3.7 Cc). 

The drug has not yet been carefully studied. It is unknown 
just what substances are incompatible with it, though the motor 
excitants are probably antagonistic. The exact physiological action 
is not definitely understood, yet so far as it has been investigated it 
seems to possess some of the properties of both the motor de- 
pressants and antispasmodics, having a sedative action upon the 
brain and spinal cord. 

Therapeutics. — The drug is valuable in the various manifesta- 
tions of hysteria, and has been employed with some success in 
ovarian neuralgia and dysmenorrhea. 

It is similar to, though not so efficient as, grindelia in spasmodic 
coughs. Indeed, most of the disorders benefited by the antispas- 
modics yield to the influence of sumbul. 

In neurasthenia with anemia the extract of sumbul, combined 
with iron and arsenic, serves a very useful purpose. 



544 A TEXT-BOOK OF MATERIA MEDICA. 

Administration. — It may be given in the form of the tincture, 
or the extract may be administered in pill form. 

Viburnum Prunifolium— Viburni Prunifolii— Black 

Haw. U. S. JP. 

Origin. — The bark of Viburnum prunifolium L., a tall shrub or 
small tree 10 to 20 feet (3-6 M.) high, growing in thickets through- 
out the greater portion of the United States east of the Mississippi. 

Description and Properties. — Thin pieces or quills, glassy 
purplish-brown, with scattered warts and minute black dots ; when 
collected from old wood, grayish-brown, the thin corky layer easily 
removed from the green layer ; inner surface whitish, smooth ; frac- 
ture short; inodorous; somewhat astringent and bitter. 

It contains a bitter principle (viburnin), a bitter resin, valerianic 
acid, besides tannic, oxalic, citric, and malic acids. 

Dose. — 30-60 grains (2.0-4.0 Gm.). 

Official Preparation. 
Extractum Vibtirni Prunifolii Fluidum — ExtrScti Viburni Prunifolii Fluidi 
—Fluid Extract of Black Haw. —Dose, %-i fluidrachm (1.8-3.7 Cc). 

Antagonists and Incompatibles. — It is chemically incompatible 
with iron and other substances affected by tannic acid. 

Synergists. — Antispasmodics and uterine sedatives. 

Physiological Action and Therapeutics. — The action of black 
haw is not thoroughly understood. It appears to have a sedative 
action upon the spinal centers, similar in many respects to that of 
conium. It acts as an antispasmodic, diuretic, nervine, and tonic, 
being especially useful in various uterine disorders, such as spas- 
modic and membranous dysmenorrhea. 

The various vaso-motor disturbances and the menorrhagia inci- 
dent to the menopause are frequently relieved by this remedy. It 
is also of some value in the prevention of abortion. Its sedative 
properties render it serviceable in relieving the severity of after- 
pains. 

Contraindications and Administration require no special com- 
ment or suggestion. 



MOTOR DEPRESSANTS. 545 

Viburnum Opulus— Viburni Opuli— Cramp Bark. 

U. S. JP. 

Origin. — The bark of Viburnum Opulus L., a small tree 10 to 
15 feet (3-4.5 M.) high, indigenous in Canada, the Northern United 
States, Europe, and Northern Asia. 

Description and Properties. — Flattish or curved bands, or 
occasionally quills, sometimes 12 inches (30 Cm.) long and from 
•Jg- to y 1 ^ inch (1-1.5 Mm.) thick; outer surface ash-gray, marked 
with somewhat transversely scattered, elongated warts of a brown- 
ish color, due to abrasion, and marked more or less with blackish 
dots, with black, irregular lines or thin ridges, arranged chiefly in 
a longitudinal direction ; underneath the easily-removed corky 
layer of a pale-brownish or reddish-brown color ; the inner surface 
dingy white or brownish ; fracture tough, the tissue separating in 
layers ; inodorous ; taste somewhat astringent and bitter. 

Dose. — 1-2 drachms (4.0-8.0 Gm.). 

Official Preparation. 
Extr^ctum Vibiirni Opuli Fluidum — ExtrScti Vibiirni Opuli Kluidi — Fluid 
Extract of Cramp Bark. — Dose, 1-2 fluidrachms (3.7-7.3 Cc). 

The general observations upon Viburnum prunifolium are appli- 
cable to this drug. 

Acidum Hydrocyanicum Dilutum— Acidi Hydrocy- 
anici Diluti— Diluted Hydrocyanic Acid. U.S.I*. 

(Prussic Acid.) 

Origin. — A liquid composed of 2 per cent, by weight of abso- 
lute Hydrocyanic Acid and 98 per cent, of Water, prepared by 
distilling a mixture of Potassium Ferrocyanide, Sulphuric Acid, 
and Water into Distilled Water. 

Description and Properties. — A colorless liquid, of a charac- 
teristic odor and taste, resembling those of bitter almonds. As it 
is very poisonous, great care should be taken in tasting it. It should 
be kept in small, dark-amber colored, cork-stoppered bottles, in 
a cool place. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Antagonists and Incompatibles. — Atropine is a physiological 
antagonist, the diffusible stimulants also counteracting the effects 
of the drug. The metallic salts, particularly cobalt nitrate, are 
chemically incompatible. 

35 



546 A TEXT-BOOK OF MATERIA MEDICA. 

Synergists. — The cardiac and motor depressants. 

Physiological Action. — Externally and Locally.— Applied lo- 
cally to the unbroken skin, its first effect is slightly irritating, but 
soon after sedative and anesthetic, because of its influence in 
causing paralysis of the sensory nerve-endings. 

It is very rapidly absorbed from raw surfaces, even toxic effects 
resulting from its application. 

Internally. — Digestive System. — Being quickly absorbed by the 
mucous membranes, hydrocyanic acid acts as an anesthetic and 
sedative upon the stomach, moderate doses having little influ- 
ence upon a healthy organism. Toxic doses may be followed by 
vomiting and the terribly lethal action of the drug, the peculiarly 
sudden and violent activity of which renders it the most fatal 
poison known. 

Circulatory System. — Prussic acid passes very readily into the 
blood, upon which it acts with physical effects variously reported, 
it having been observed that the blood is at first changed to a 
bright red or arterial tint, soon changing to a dark venous color. 
Upon the heart its influence, though in small doses sedative 
through stimulation of the vagus center, in toxic doses is particu- 
larly active, suspending its movements and arresting it in diastole. 

A temporary, yet doubtful, increase, followed by a decline, of 
arterial pressure has been noted. In lethal doses the decrease of 
tension is unquestionable. Observations upon the physiological 
effects of prussic acid have been attended with considerable dif- 
ficulty : a slow and frequently irregular pulse, however, is among 
the authenticated phenomena. By its action on the respiratory 
functions of the red blood-corpuscles the supply of oxygen to the 
circulation is impeded. 

Nervous System. — Medicinal doses have no appreciable effect 
save to occasion a depression of the sensory fibers of the vagus. 
The cerebral effects of large doses are giddiness and stupor, often 
accompanied by total insensibility or coma. Toxic doses produce 
marked cutaneous anesthesia, beginning in the lower extremities, 
caused by paralysis of the sensory ends and sensory tracts. 

The motor mechanism shares in the general influence, which 
causes excessive muscular weakness, resulting from depression of 
the spinal motor areas, the ends of the motor nerves, and the mus- 
cles respectively. 

Respiratory System. — Very small doses of hydrocyanic acid have 
no effect upon respiration. Full or large doses have been observed 



MOTOR DEPRESSANTS. 547 

to render the breathing labored and irregular. Under toxic doses 
the respiration becomes enfeebled, finally ceasing altogether, death 
ensuing from asphyxia due to paralysis of the respiratory move- 
ments by direct action upon the center. It has been noted that 
lethal doses are so quickly fatal that the respirations cannot be 
counted. 

Absorption and Elimination. — As has been remarked, absorption 
takes place with great rapidity, elimination being probably through 
the kidneys, salivary glands, and lungs, the process being accel- 
erated by means of the drug's exceeding volatility. In case of 
poisoning, should death be averted for half an hour there is chance 
of recovery. 

Temperature. — No special influence has been observed. 

Eye. — The pupils are, as a rule, visibly dilated under serious 
dosage, a temporary hemianopia having been also observed in a 
case of poisoning with recovery. 

Untoward Action. — There are no untoward manifestations save 
those described under " Poisoning." 

Poisoning. — The celerity of action characteristic of prussic acid 
is evidenced by the fact that death may be instantaneous, the sub- 
ject falling with a gasp and momentary convulsion, followed by 
immediate collapse. In such cases the countenance is cyanotic, the 
teeth firmly set, the eyes wide open, and the lips covered with 
bloody froth. In less violent cases the symptoms may take the 
form of reduced respiration, impairment of cardiac movements, and 
cerebral disturbance. A third stage is marked by wide dilatation 
of the pupils, loss of consciousness, delirious cries, accompanied 
by strong convulsions, vomiting, incontinence of urine, involuntary 
defecation, and even erections of the penis and ejaculations of 
semen (Hare). In still another stage asphyxia, collapse, and death 
occur in rapid succession. 

Treatment of Poisoning. — Owing to the physical action of 
prussic acid upon the blood, artificial respiration is generally pow- 
erless to avert fatal results (Ringer). Efficient antidotes are 
ammonia and its carbonate, to be administered whenever prac- 
ticable. Alcoholic stimuli may prove of service, yet the fearful 
rapidity of the drug's action renders poisoning by prussic acid 
rarely amenable to systematic treatment. 

A vigorous recourse to alternately warm and cold affusions, 
together with inhalations of ammonia, has been recommended as 
of primary importance. Secondary means of allaying toxic effects 



54 8 A TEXT-BOOK OF MATERIA MEDICA. 

may be found in the internal administration of chlorine water or 
of potassium carbonate, followed by the sulphates of iron. 

More recently the subcutaneous injection of atropine has been 
suggested as the true physiological antidote (Farquharson), while 
Dr. Antal considers cobalt nitrate the best chemical antagonist. 
The most recent studies show that the best . chemical antidote is 
solution of hydrate of iron with excess of an alkali, magnesia 
being the best. So long as the faintest pulsation is discernible 
no efforts at recovery should be remitted. 

Therapeutics. — Externally and Locally. — Hydrocyanic acid is 
a valuable antipruritic, being frequently employed to relieve the 
itching of various diseases of the skin, such as eczema, erythema, 
urticaria, pruritus vulvce, etc. It is commonly applied in strengths 
of \ fluidrachm (1.8 Cc.) to 1 ounce (30.0 Cc.) of water. 

Inhalations of a solution containing 3 minims (0.18 Cc.) of 
diluted hydrocyanic acid to 8 ounces (2^6.6 Cc.) of water at a 
temperature of 120 F. have been recommended by Mackenzie 
and others in asthma and the irritative cough of phthisis. 

Internally. — Its sedative properties render the drug an efficient 
remedy in obstinate vomiting and gastric pain from whatever 
cause. It is also valuable to relieve coughs of a dry, hacking 
nature, whooping cough, and various neuroses of the respiratory 
organs. Macdonald reports a case of night cough of a child that 
yielded promptly to hydrocyanic acid after every other treatment 
had been tried in vain. 

The drug has been used in 7ieuralgia, acute mania, and melancho- 
lia. In irritable conditions of the heart it serves as a useful palliative, 
and is also of value in relieving the distress of irritative dyspepsia. 

Contraindications. — Extreme muscular weakness and the last 
stages of valvular heart disease. 

Administration. — Owing to the exceedingly rapid elimination 
of prussic acid the dose should be frequently repeated — every 
hour or two. In the early administration the minimum dose 
should be first prescribed, the amount being gradually increased to 
the maximum or until the patient complains of constriction about 
the throat or other untoward manifestation, when the dosage should 
be discontinued. Whenever a fresh supply is prescribed it is best 
to begin with the minimum dose, owing to the variations in strength 
in the different samples. 

Hydrocyanic acid may be given in syrup, water, or glycerin, or 
in some effervescent draught. 



MOTOR DEPRESSANTS. 549 

Potassii Cyanidum— Potassii Cyanidi— Potassium 
Cyanide. XT. S. P. 

Origin. — Prepared by heating in an iron crucible a mixture of 
exsiccated Potassium Ferrocyanide 8 parts and Potassium Carbon- 
ate 3 parts until effervescence ceases. 

Description and Properties. — White, opaque, amorphous pieces, 
or a white, granular powder, odorless when perfectly dry, but in 
moist air exhaling the odor of hydrocyanic acid. The taste is 
sharp and somewhat alkaline, but should be ascertained with great 
care, as the salt is very poisonous. In moist air it deliquesces ; 
soluble in about 2 parts of water and sparingly soluble in alcohol. 
Potassium cyanide should be kept in well-stoppered bottles. 

Dose. — ^g— J- grain (0.004-0.008 Gm.). 

Cyanide of potassium differs from hydrocyanic acid, with which 
it generally assimilates, in being less rapid in its action, producing 
dermatitis or eczematous eruption by local application to the epi- 
dermis, and in its possibly fatal results from free contact with 
abraded surfaces. 

The therapeutic uses are practically those of hydrocyanic acid. 

Amyl Nltris— Amyl Nitritis— Amyl Nitrite. U.S. P. 

Origin. — Obtained by the action of Nitric Acid upon Amylic 
Alcohol — a liquid containing about 80 per cent, of amyl (princi- 
pally iso-amyl) nitrite, together with variable quantities of unde- 
termined compounds. 

Description and Properties. — A clear yellow or pale-yellow 
liquid, of a peculiar, ethereal, fruity odor and a pungent, aromatic 
taste. Almost insoluble in water ; miscible in all proportions with 
alcohol or ether. In alcoholic solution it gradually decomposes, 
with formation of ethyl nitrite and amylic alcohol. It should be 
kept in small, dark-colored, glass-stoppered bottles, in a cool and 
dark place, remote from lights and fire. 

Dose. — J- 1 minim (0.03-0.06 Cc.) internally; for inhalation 1-5 
minims (0.06-0.3 Cc). 

Antagonists and Incompatibles. — The motor excitants antago- 
nize the action of amyl nitrite. 

Synergists. — The motor depressants. 

Physiological Action. — Externally and Locally. — Its action is 
that of a mild irritant when applied to the skin. 

Internally. — The following actions apply to ingestion or inhala- 
tion of the drug. 



55° A TEXT-BOOK OF MATERIA MEDICA. 

Digestive System. — No important action has been observed. 

Circulatory System. — Almost immediately after inhalation of 
amyl nitrite there is a marked flushing of the skin, first perceptible 
in the face, doubtless occasioned by dilatation of the capillaries. 
The heart's action is increased and somewhat weakened, and the 
pulse is soft and compressible. The blood-pressure falls very 
markedly, the condition being caused by a paralyzing action upon 
the muscle-fibers found in the walls of the small arterioles, causing 
marked dilatation. The same cause accounts for the change in the 
action of the heart, due to diminution of peripheral resistance. 
Amyl nitrite has no central action. 

The inhalation of large amounts renders the heart very weak, 
toxic doses arresting that organ in diastole. The functional activ- 
ity of the hemoglobin is checked, giving to the arterial and venous 
blood a dark chocolate color. 

Nervous System. — Among the effects are cerebral oppression, 
flushing of the head and face, vertigo, headache, and confusion of 
ideas, with diminished reflex excitability, muscular weakness, and 
unsteadiness of gait, both the voluntary and involuntary muscles 
being relaxed. These actions are due to the depressing influence 
of the drug upon the motor areas of the brain and spinal cord. 

Respiratory System. — Small doses quicken the respiration by 
lowering arterial pressure and possibly by moderate stimulation of 
the center, due to accumulation of carbon dioxide. Immoderate 
or toxic amounts render the breathing slow and labored from 
depression of the respiratory center and arrest of the oxygenating 
function of the blood. 

Absorption and Elimination. — Amyl nitrite is rapidly absorbed, 
being eliminated chiefly by the kidneys, increasing the amount of 
urine, uric acid, and urea excreted. Sugar may frequently be de- 
tected in the urine, probably resulting from the action of the drug 
in dilating the hepatic vessels and increasing the circulation in the 
liver. 

Temperature. — Bodily heat is reduced both in health and in 
fever, due to dilatation of the peripheral blood-vessels and a reduc- 
tion of the oxygen-carrying power of the red blood-corpuscles. 

Eye. — There is marked dilatation of the retinal vessels and 
hyperemia of the papilla, producing chromatopsia of the parti- 
colored variety and hallucinations of vision. These effects are 
usually transitory, and disappear with the elimination of the drug. 

Uterus. — The uterine muscle is relaxed. 



MOTOR DEPRESSANTS. 551 

Untoward Action. — In addition to the symptoms described under 
" Poisoning," there have been noted gastric disturbance, nausea and 
vomiting, dryness of the mouth and trembling of the lips, irritation 
of the throat, defective vision, and subjective sensations of color, 
usually yellow vision. 

Poisoning. — The toxic effects of amyl nitrite include an exceed- 
ingly rapid and weak heart, final retardation of the pulse, cyanosis 
of the face, slow and shallow respiration, cold extremities, subnor- 
mal temperature, great muscular weakness, abolished reflexes, 
vertigo, intense headache, and disordered vision. Death results 
from cardiac or respiratory failure. 

Treatment of Poisoning. — Strychnine and digitalis are required 
to sustain the heart ; ergotin or atropine may be administered sub- 
cutaneously, together with cold applications to the head, diffusible 
stimulants, and artificial respiration if necessaiy. 

Sodii NItris— Sodii Nitrltis— Sodium Nitrite. U. S. JP. 

Origin. — Obtained by heating Sodium Nitrate with Lead, the 
oxygen from the nitrate being abstracted by the lead oxide formed. 

Description and Properties. — White, opaque, fused masses, 
usually in the form of pencils, or colorless, transparent, hexagonal 
crystals ; odorless, and of a mild, saline taste. When exposed to 
the air the salt deliquesces and is gradually oxidized to sodium 
nitrate. Soluble in about 1.5 parts of water; slightly soluble in 
alcohol. It should be kept in well-stoppered bottles. 

Dose. — 2-5 grains (0.12-0.3 Gm.). 

Splritus Glonolni— SpTritus Glonolni— Spirit of Glo- 

noin. U.S.I*. 

(Spirit of Nitroglycerin.) 
An alcoholic solution of 1 per cent, of nitroglycerin. 
Origin. — Nitroglycerin is obtained by gradually adding Dehy- 
drated Glycerin to a mixture of Nitric and strong Sulphuric Acid, 
the nitroglycerin formed being washed with water and dilute soda 
solution to remove all acid. 

Description and Properties. — Nitroglycerin occurs as a clear, 
colorless liquid possessing the odor and taste of alcohol. It 
should be tasted and handled with great caution, since it is apt to 
produce violent headache, whether ingested or applied to the skin. 
It explodes with great force, and should be kept in a cool place, 
remote from lights or fire. 



552 A TEXT-BOOK OF MATERIA MEDICA. 

Dose. — 1-3 minims (0.06-0.18 Cc.) of the spirit. 

The actions of sodium nitrite and nitroglycerin are very similar 
to those of amyl nitrite, although they are less prompt, while more 
persistent. Nitroglycerin produces a frontal headache of much 
greater intensity than that caused by amyl nitrite. This is also 
true of sodium nitrite, though the headache it occasions is less 
severe than that resulting from nitroglycerin. 

Both the sodium nitrite and nitroglycerin are preferable to the 
amyl nitrite for internal administration. 

Therapeutics. — Externally and Locally. — The nitrites are not 
used for external purposes. 

Internally. — The property of amyl nitrite in suddenly lowering 
arterial pressure and dilating the arterioles renders it of inestima- 
ble value as a relief for the terrible precordial pain in angma 
pectoris. 

Epileptic seizures may often be aborted by the instant inhalation 
of amyl nitrite upon the first indication of the aura epileptica. The 
drug has also been successfully employed for the relief of asthma, 
particularly the uremic form, as well as for cardiac dyspnea and 
puerperal eclampsia. 

Like many other motor depressants, it has been used in the 
treatment of tetanus and strychnine-poisoning. It has proved an 
efficient preventive for the chill occurring in virulent malarial fever, 
and has served as a valuable antidote in poisoning from chloroform. 

The drug is indicated in all conditions of high arterial tension, 
as in chronic nephritis, etc. It is also beneficial in congestive dys- 
menorrhea. 

The sodium nitrite is used for the same purposes as the amyl 
nitrite, though superior to it for internal administration, as in cases 
of abnormally high arterial tension. 

Nitroglycerin is specially adapted for the treatment of cardi- 
opathies occurring after middle life. It is useful in chronic nephritis 
with high arterial tension, and, associated with digitalis, is recom- 
mended in certain cases of pneumonia. The tendency to increase 
of peripheral resistance in the vessels after adult life is attained 
renders possible the favorable administration of doses of nitroglyc- 
erin intolerable in early life. 

The drug is often of marked benefit in the arrhythmia of slightly 
enlarged and degenerated hearts with arteriosclerosis. It is also 
of considerable value in relieving the pseudo-anginas which are 
frequently a feature of vascular disease. It should be given in 



MOTOR DEPRESSANTS. 553 

doses of 2-g-o to tot g ram (0.00032-0.0006 Gm.) twice or four 
times daily. 

Osier recommends the prolonged administration of nitroglycerin 
in locomotor ataxia, affirming that it lessens the frequency of the 
crises and relieves the neuralgic pains. 

The drug is of use in sciatica, and frequently relieves obstinate 
hiccough. It has been recommended for the same diseases for 
which amyl nitrite is used. 

Other Nitrites. 

Erythrol tetra-nitrate is an organic nitrate that has a similar 
action to the nitrites. Its action is more prolonged, and is there- 
fore to be recommended in chronic conditions. Dose, \ grain 
(0.5 Gm.). 

A large number of nitrites of this general group are under 
investigation. 

BROMIDES. 

Potassii Bromidum— Potassii Bromidi— Potassium 
Bromide. U. S. JP. 

Origin. — Prepared by adding Bromine to a solution of Potassa, 
evaporating to dryness, mixing with Charcoal, heating to redness, 
dissolving in Water, and crystallizing. 

Description and Properties. — Colorless or white, cubical crys- 
tals or granules, odorless, with a pungent, saline taste ; permanent 
in air; soluble in about 1.6 parts of water and in 200 parts of 
alcohol. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 



Sodii Bromidum— Sodii Bromidi— Sodium Bromide. 

U. S. P. 

Origin. — Obtained from a solution of Soda in the same manner 
as Potassium Bromide. 

Description and Properties. — Colorless or white, cubical crys- 
tals, or a white, granular powder, odorless, and with a saline, 
slightly bitter taste. From air the salt abstracts moisture without 
deliquescing. Soluble in 1.2 parts of water and in 13 parts of 
alcohol. It should be kept in well-stoppered bottles. 

Dose. — 10-60 grains (0.6-4.0 Gm.). 



554 A TEXT-BOOK OF MA TERIA MEDICA. 

Ammonii Bromidum— Ammonii Bromidi— Ammo- 
nium Bromide. XT. S. I*. 

Origin. — Obtained by neutralizing Hydrobromic Acid with 
Ammonia or Ammonium Carbonate, evaporating, and crystallizing. 

Description and Properties. — Colorless, transparent, prismatic 
crystals, or a white, crystalline powder, odorless, and of a pungent, 
saline taste; permanent in the air. Soluble in 1.5 parts of water 
and in 30 parts of alcohol. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Lithii Bromidum— Lithii Bromidi— Lithium Bromide. 

77. S. JP. 

Origin. — Prepared by a solution of Ferrous Bromide and Lithium 
Carbonate, the cool liquid being evaporated and crystallized. 

Description and Properties. — A white, granular salt, odorless, 
and having a sharp, slightly bitter taste ; very deliquescent. Solu- 
ble in 0.6 part of water and very soluble in alcohol. It should be 
kept in well-stoppered bottles. 

Dose. — 5-20 grains (0.3-1.2 Gm.). 

Calcii Bromidum— Calcii Bromidi— Calcium Bro- 
mide. U.S.JP. 

Origin. — Prepared by dissolving pure Calcium Carbonate in 
Hydrobromic Acid and evaporating. 

Description and Properties. — A white, granular salt, odorless, 
of a sharp, saline taste and very deliquescent. Soluble in 0.7 part 
of water and in 1 part of alcohol. It should be kept in well- 
stoppered bottles. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

ZInci Bromidum— Zinci Bromidi— Zinc Bromide. 

U. S. JP. 

Origin. — Prepared by digesting Granulated Zinc in Hydrobromic 
Acid, concentrating the solution, acidulating with Hydrobromic 
Acid, and drying upon a water-bath. 

Description and Properties. — A white, granular powder, odor- 
less, and having a sharp, saline, and metallic taste. Very deliques- 
cent. Readily soluble in water and alcohol. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 



MOTOR DEPRESSANTS. 555 

Strontii Brdmidum— Strontii Bromidi— Strontium 
Bromide. U. S. r. 

Origin. — Obtained by neutralizing Hydrobromic Acid with 
Strontium Carbonate, filtration, and evaporation. 

Description and Properties. — Colorless, transparent, hexagonal 
crystals, odorless, and having a bitter, saline taste. Very deliques- 
cent. Soluble in 1.05 parts of water and readily soluble in 
alcohol. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Acidum Hydrobromicum Dilutum— Acidi Hydro- 
bromici Diluti — Diluted Hydrobromic Acid. 
77. 8. JP. 

Origin. — A liquid composed of 10 per cent, by weight of Abso- 
lute Hydrobromic Acid and 90 per cent, of Water. 

Description and Properties. — A clear, colorless liquid, odor- 
less, and having a strongly acid taste. Miscible in all proportions 
with water and alcohol. It should be kept in glass-stoppered 
bottles, protected from light. 

Dose. — 20 minims-2 fluidrachms (1.23-7.39 Cc). 

Bromoformum— Bromoformi— Bromoform 

(Unofficial). 

Origin. — Obtained by the action of Bromine upon equal parts 
of Methyiic Alcohol and Caustic Potash. 

Description and Properties. — A colorless, limpid liquid with 
an agreeable odor and sweet taste. Insoluble in water, but soluble 
in alcohol and ether. It should be kept in well-stoppered, dark, 
amber-colored bottles. 

Dose. — 1-5 minims (0.06-0.3 Cc). 



Antagonists and Incompatibles. — The bromides are antago- 
nized by the motor excitants and cardiac stimulants. The incon? . 
patibles are acids, acidulous and metallic salts. Spirit of nitrous 
ether is incompatible with the ammonium bromide. 

Synergists. — Their action upon the brain is enhanced by opium 
and the hypnotics, while the cardiac depressants increase their 
effect upon the circulatory system. 

Physiological Action. — The action of potassium bromide is 
here given, that being the type of the group : later the comparative 
actions of the various members will be considered. 



556 A TEXT-BOOK OF MA TERIA MEDICA. 

Externally and Locally. — Potassium bromide is slightly seda- 
tive to mucous membranes when applied locally, lessening the 
reflex irritability, particularly of the pharynx. 

Internally. — Digestive System. — No effect is produced by mod- 
erate amounts. Excessive doses have occasioned a sense of cold- 
ness in the epigastrium, with nausea and looseness of the bowels. 

Circulatory System. — The bromides depress the circulation, 
causing the pulse to become slower, softer, and weaker, and short- 
ening the systole while prolonging the diastole of the heart. The 
caliber of the vessels is diminished, although arterial pressure is 
lowered. Arterial anemia of the brain is present, owing to the 
contraction of the blood-vessels and diminished arterial pressure. 
Toxic doses of potassium bromide cause dilatation of the heart 
and paralysis in diastole. 

The exact points where the bromides act to cause this circula- 
tory depression are undetermined. 

Nervous System. — When given for a long time or under large 
dosage the bromides depress the cerebral cells, producing somno- 
lence, reducing the excitability of the brain, and, if long continued, 
impairing the memory and intellect. 

Under their influence there is marked depression of the motor 
mechanism, resulting in muscular weakness. Every possible point 
of the apparatus is depressed — the cerebral and spinal motor areas, 
the spinal motor tracts, the ends of the motor nerves, and even 
the muscles themselves. 

Bromides also lessen greatly the reflex excitability of the spinal 
cord. As in their action upon the motor mechanism, they depress 
every part of the reflex apparatus — the ends of the afferent and 
efferent nerves and tfie reflex center wherever it may be. 

The sensory mechanism is therefore impaired, causing dimin- 
ished sensibility of the skin and mucous membranes. 

The functional activity of the sexual organs is considerably less- 
ened by these drugs. 

Respiratory System. — Under full doses the respirations are 
slower and shallower, owing to depression of the respiratory 
center, paralysis of which usually causes death, although fatal 
paralysis may affect the heart because of the poisonous influence 
of the potassium upon the cardiac muscle. 

Absorption and Elimination. — The bromides are very rapidly 
absorbed, having been found in the urine ten minutes after their 
ingestion (Dujardin-Beaumetz), and are quickly eliminated, chiefly 



MOTOR DEPRESSANTS. 557 

by the kidneys, increasing the flow of urine, and also by the skin, 
saliva, intestinal and mammary glands, and the bronchial mucous 
membrane. The sulphur and nitrogen in the urine are increased 
and the amount of phosphorus decreased. 

Notwithstanding the rapid elimination of the bromides, under 
prolonged administration they tend to accumulate in the system, 
being found abundantly in the nerve-centers. 

Temperature. — Immoderate doses cause a reduction of temper- 
ature, due to depression of the circulation and lessening of tissue- 
change. 

Eye. — There may occur dilatation of the pupil, conjunctival 
catarrh, diplopia, amblyopia, dimness of vision, and dilatation of 
the retinal blood-vessels. 

Uterus. — A diminution of the catamenia may sometimes be 
present. 

Untoward Action. — The susceptibility of individuals to the un- 
toward action of the bromides is extremely variable. The symp- 
toms observed are — gastric uneasiness with eructation, nausea and 
vomiting, analgesia of the epiglottis and pharynx, bronchial catarrh, 
hoarseness and cough, acute coryza and conjunctivitis, offensive 
breath, dysuria, diminished sensibility of the genito-urinary mucous 
membrane, and a variety of cutaneous eruptions. 

Poisoning. — Bromism,a.s> the symptoms of poisoning are termed, 
may be divided into acute and chronic. 

Acute bromism, resulting from a single toxic dose, is manifested 
by violent frontal headache, great muscular weakness, incoordi- 
nation of movements, abolition of reflexes, somnolence, slow and 
shallow breathing, subnormal temperature, lustreless eyes, and 
very slow and weak pulse, death resulting from either respiratory 
or cardiac failure. 

Chronic bromism, caused by prolonged use of the bromides, is 
characterized by mental apathy, constant drowsiness, hallucination 
or melancholia, considerable cutaneous anesthesia, muscular weak- 
ness, poor circulation, cold extremities, marked anemia, impairment 
of the sexual function, deranged digestion, and cutaneous eruptions 
of various forms collectively designated as " bromine acne." 

Treatment of Poisoning. — The drug should be immediately 
withdrawn and methods adopted to hasten elimination, such as the 
administration of diuretics, cathartics, etc. Tonics, such as strych- 
nine, iron, and the cardiac stimulants, should be given, while exer- 
cise and change of scene may counteract the psychical symptoms. 



558 



A TEXT-BOOK OF MATERIA MEDICA. 



It is claimed that the daily administration of Fowler's solution 
causes a rapid disappearance of the bromine eruption. 

Comparative Action of the Bromides. — Potassium bromide 
contains 66 per cent, of bromine. It is the least hypnotic and most 
toxic to the heart and muscular system. 

Sodium bromide, 78 per cent, of bromine, is more hypnotic, but 
much less toxic, than the potassium salt. Its effect upon the cir- 
culation is the most pronounced of all the bromides. 

Ammonium bromide is less toxic and more stimulating than 
potassium bromide, though resembling it in other respects. 

Lithium bromide is the richest in bromine, containing 92 per 
cent., and is probably the most hypnotic of all. Its action more 
nearly resembles that of the sodium salt. 

Calcium bromide, while resembling them in its action, is less 
energetic than the other bromides. 

Zinc bromide is the most irritant, and is supposed to possess 
both tonic and sedative properties. 

Strontium bromide is the mildest of all, being less prone to 
cause bromism. 

Diluted hydrobromic acid in its action 
resembles the bromides, though much less 
depressant than the potassium salt, and less 
likely to occasion symptoms of chronic 
poisoning. 

Therapeutics. — Externally and Locally. 
— Pharyngitis is relieved by a gargle con- 
taining potassium bromide and potassium 
chlorate. A solution of potassium bromide 
diminishes the sensibility of the throat, so 
that examinations are more easily made. 
A solution of 4 parts of potassium bromide 
in 20 parts of glycerin affords a soothing 
lotion in painful hemorrhoids. It is asserted 
that the powdered salt has been dusted 
over indolent ulcers with benefit. 

Internally. — The bromides are especially 
useful in allaying excessive brain activity, 
the insomnia (particularly the sleeplessness 
dependent upon nervous excitement, ex- 
haustion, and irritability) and headache of cerebral congestion yield- 
ing readily to these remedies. 




Fig. 11. — Diagram showing 
how irritation of the dental nerve 
in teething, by stimulating the 
sensitive reflex mechanism of the 
infant, may produce strabismus 
(3), cough (Z>, K), indigestion 
(L), diarrhea (M), and convul- 
sions (JY). 



MOTOR DEPRESSANTS. 559 

They are undoubtedly the most efficient medicinal agents for 
the relief of epilepsy, being given either alone or in combination 
with some vegetable bitter. Fere combines with them an intesti- 
nal antiseptic, asserting that the union lessens the tendency to 
bromism. Bechterew highly recommends a combination of the 
bromides with Adonis vernalis. 

Being such marked depressants of the reflex centers, they are 
of decided benefit in nervous spasmodic disorders, and particularly 
valuable in infantile convulsions. 

During dentition children suffer from various disturbances due 
to irritation of the dental nerve — convulsions, cough, indigestion, 
diarrhea, strabismus, etc. — in all of which the bromides, being 
powerful depressants of the reflex mechanism, prove of great value. 
(See Diagram 1 1 .) 

Whenever there is increased reflex excitability the bromides are 
indicated. They are therefore valuable in the reflex disturbances of 
the menopause, spasmodic asthma, laryngismus stridulus, whooping 
cough, and other coughs of reflex origin. They have also been used 
in tetanus and strychni?ie-poiso?iing. 

Excessive nervous irritability is quickly relieved by these reme- 
dies, either singly or in combination with some of the antispas- 
modics, such as asafetida, valerian, etc. 

Because they depress the sexual mechanism they are of decided 
benefit in spermatorrhea of the plethoric or in the condition arising 
from irritation of the deep urethra. Menorrhagia resulting from 
excessive ovarian excitement is frequently relieved by these agents, 
while nymphomania and delirium tremens are often greatly benefited 
by full doses of the bromides. 

The ammonium bromide has been employed with benefit, it is 
said, in diabetes of nervous origin. Cerebral vomiting and the 
vomiting of pregnancy are sometimes singularly amenable to the 
influence of the bromides. 

The author is quite partial to a combination of sodium bromide, 
spirit of nitrous ether, and tincture of aconite, in anise water, as a 
remedy in acute febrile attacks of children with delirium. Small 
doses are given at frequent intervals until there is a decided im- 
provement in the symptoms. 

The bromides are claimed to be of value in acute and muscular 
rheumatism. The lithium salt is undoubtedly of service in these 
cases and in the uric-acid diathesis. 

The sedative action upon the circulatory apparatus exerted by 



560 A TEXT-BOOK OF MATERIA MEDIC A. 

the bromides renders them valuable in cardiac irritability when not 
due to anemia. They are particularly useful in quieting the heart's 
action in exophthalmic goiter. 

Augagneur advises the use of the bromides together with the 
iodides in the treatment of syphilis, believing that their administra- 
tion prevents such untoward manifestations as dysphonia y aphonia, 
or dyspnea in laryngeal syphilis. 

The strontium bromide is highly recommended in fermentative 
dyspepsia due to decomposition of food. 

Bromoform ranks to-day superior to all other remedies in the 
treatment of whooping cough, an overwhelming amount of authori- 
tative evidence tending to prove that the drug not only greatly 
curtails the duration of the disease, but mitigates the severity of 
the paroxysms and renders them less frequent. 

Bromoform has also been highly recommended in acute mania 
and delirium treme7is. 

Diluted hydrobromic acid is used for the same purposes as 
the bromides, some clinicians preferring it to the latter to quiet the 
delirium of simple continued fevers. It is employed extensively 
to relieve the symptoms of cinchonism. 

Contraindications. — The bromides are contraindicated in con- 
ditions of great debility, anemia, or fatty or weak heart with low 
arterial pressure. 

Administration. — The bromides should be given in solution, 
and when long continued, as in the treatment of epilepsy, they 
should be accompanied by restorative agents. Carbonated waters, 
milk, and aromatic elixir serve as efficient vehicles to disguise the 
taste of these salts. 

Children acquire a remarkable tolerance for the bromides, so 
that large doses may be given them with but little danger. 

Bromoform may be dropped into a spoonful of water and ad- 
ministered in this simple manner, or it may be dissolved in gly- 
cerin. P. W. Bedford has originated a formula which makes an 
exceedingly palatable and perfect solution : 

Bromoformi, 1T|xvj (1.0 Cc); 

Alcoholis, 

Tincturae Cardamomi Composite, ad. fgij (7.39 Cc.) ; 

Glycerini, q. s. ad. 51J (60.0 Cc). 

Each fluidrachm contains I minim (0.06 Cc.) of bromoform. 

Bromoform has given poisonous effects. 

The diluted hydrobromic acid should be given in water or syrup. 



CARDIAC STIMULANTS. 561 

GROUP VIII.— CARDIAC STIMULANTS. 1 

Cardiac remedies may be divided into Cardiac Tonics, Cardiac 
Stimulants, and Cardiac Sedatives or Depressants. The grouping 
is a rational one, both from a clinical and a physiological point of 
view, although the Cardiac Sedatives are at present much more 
limited in their clinical application than they were a few years 
ago, being used principally in sthenic fevers with excessive cardiac 
action. 

Cardiac Tonics. — By these are implied those drugs which add 
tone to the cardiac muscle and the nervous mechanism of the heart, 
increasing the nutrition of that muscle, and consequently augment- 
ing its capacity for work. 

The cardiac tonics have little or no effect upon the dynamic 
force exerted through the contraction of the heart-muscle, herein 
lying their essential distinction from cardiac stimulants, which affect 
per se the muscular contractile force. 

The proper period for the employment of cardiac tonics antici- 
pates that where the exhibition of cardiac stimulants becomes neces- 
sary. They are, moreover, prophylactic against the latter contin- 
gency, preventing the development of a hyposystolic condition of 
the heart. They are also indicated subsequent to the temporary 
use of cardiac stimulants to improve the nutrition of the heart and 
maintain the beneficial results of stimulation. 

Cardiac tonics should be given in small doses and the adminis- 
tration prolonged. 

The principal members of the group are — strychnine, the 
iodides, arsenic, and iron, to which should be added mercury in 
small doses. The most useful are strychnine and the iodides, and 
they are well adapted for combined administration. 

Since most cases requiring the exhibition of this class of 
remedies occur after middle life, they are especially benefited by 
the action of strychnine on the cardiac nervous system and the 
increased nutrition to the heart-muscle through the effect of the 
iodides on the smaller vessels. The progressive tendency of after- 
lifetime toward loss of elasticity and a contraction of the smaller 
arteries is opposed by the action of the iodides in dilating these 
vessels. 

1 The author is indebted to Joseph M. Patton, M. D., Professor of Medicine in the 
Chicago Policlinic, for valuable assistance in preparing the present group, his observa- 
tions on therapeutics being occasionally cited verbatim. 
36 



562 A TEXT-BOOK OF MATERIA MEDICA. 

The advantage of prolonged administration of mercury in 
small doses in chronic cardiopathies during or after middle life 
is probably due to the stimulating effect of the drug on the func- 
tions of elimination. 

Mercury is adapted to nearly all senile cardiopathies, particu- 
larly in conditions of general vascular sclerosis, the most desirable 
form being the bichloride or red iodide in doses of -^ grain (0.00 1 
Gm.) three times daily. 

Arsenic may be used in the form of the arsenic iodide or as 
Fowler's solution. It is of special value in anemic conditions 
associated with cardiopathies in young persons. 

The most eligible form of iron for cardiac patients, especially 
after middle life, when elimination is an important consideration, is 
the liq. ferri et ammonii acetatis (Basham's mixture), or the 
so-called tasteless tincture of iron, with which the tincture of 
nux vomica may be well combined. 

The physiological action and further medical uses of these 
cardiac tonics are more fully described under their respective 
heads. 

Cardiac Stimulants. — As cardiac stimulants are designated 
those drugs endued with the specific property of lengthening and 
invigorating the contraction of the cardiac muscle. This effect 
would necessarily be more or less temporary, and, while some 
permanent benefit may be derived from improved nutrition result- 
ing from a better blood-supply afforded by these agents, they are 
adapted only for passing administration and are not true cardiac 
tonics. 

The general indication for the employment of this class of 
remedies rests in the presence of dynamic insufficiency of the 
muscle, which may be either actual or relative, as is the case of 
increased peripheral resistance to the blood-current. In the latter 
instance it is evident that the extracardiac obstruction must be 
removed before the salutary effects of cardiac stimulants can be 
obtained. 

It is in actual failure of the contractile force of the cardiac 
muscle that these stimulants display their most beneficial influence. 
This failure is due to a greater quantity of blood in the cavity than 
the muscle is able to cope with. The amount of dynamic force 
required at each contraction to expel this quantity is so great that 
the muscle is unable to withstand the pressure without stretching, 
and consequently dilatation is developed. Here the favorable 



CARDIAC STIMULANTS. 563 

action of cardiac stimulants is manifest, since by stimulating the 
muscle to more vigorous contraction the equilibrium of the circu- 
lation is maintained until compensatory increase in muscular 
power has had time to develop. 

The principal cardiac stimulants are — Digitalis, Strophan- 
tus, Caffeine, Alcohol, Ammonia, Spartein, Cactus grandi- 
flora, Adonis vernalis, and Convallaria, all fully described 
under their respective heads. 

In addition to these, strychnine, opium, and nitroglycerin are 
sometimes used as cardiac stimulants. They are fully described 
under their respective heads. 

Digitalis is the typical medicament of the group, after many 
years still retaining its place as the most trustworthy and generally 
useful cardiac stimulant. 

Digitalis— Digitalis— Digitalis. U. S. -P. 

(FOX- GLOVE.) 

Origin. — The leaves of Digitalis purpurea L., collected from 
plants of the second year's growth. The plant is a biennial, 2-5 
feet (0.6-1.5 M.) high, indigenous in Southern and Central Europe, 
and growing wild as far north as Norway. It is also found in 
Madeira and the Azores, and is well known everywhere as an 
ornamental garden plant. 

Description and Properties. — From 4 to 12 inches (10-30 
Cm.) long, ovate or ovate-oblong, narrowed, with a petiole, crenate, 
dull green, densely and finely pubescent, wrinkled above, paler and 
reticulate beneath, midrib broad near the base ; odor slight, some- 
what tea-like ; taste bitter, nauseous. The leaves of mullein, Inula 
coryza and Inula helenium, are sometimes mixed with those of 
fox-glove. 

The study of the active principles is fraught with much difficulty, 
and at the present time it is not a settled matter. The following 
are among the most important constituents : Digitalin, C^H^O^, a 
crystalline glycosidal substance, insoluble in water. Digitalin is 
found mostly in the seeds. Digitonin, Q-H^O^, is another con- 
stituent of the seed, and is a white, powder-like glycoside resem- 
bling saponin. It is difficultly soluble in water, but more so if 
digitalin is present. It is soluble in alcohol. It is an active 
diuretic principle ; Digitoxin, C 35 H 54 O u , is the chief glycoside of 
the leaves and the most active constituent of the plant. It is in- 
soluble in water, soluble in alcohol, chloroform, and ether ; Digi- 



564 A TEXT-BOOK OF MA TERIA MEDICA. 

tophyllin, C 32 H 52 O 10 , is another glycoside derived from the leaves. 
It resembles digitoxin. Digitalein and digitin may also be present, 
but these are either inert or identical with other constituents. 
Dose. — \-2 grains (0.03-0.12 Gm.). 

Official Preparations. 

Extr&ctum Digitalis — ExtrScti Digitalis — Extract of Digitalis. — Dose, \-\ 
grain (0.01-0.03 Gm.). 

Extr^ctum Digitalis Fluidum— ExtrScti Digitalis Fluidi— Fluid Extract 
of Digitalis. — Dose, %,-2. minims (0.03-0.12 Cc). 

Infusum Digitalis — Infusi Digitalis — Infusion of Digitalis (i}4 per cent.). — 
Dose, 1-4 fluidrachms (3.7-15 Cc). 

Tinctura Digitalis — Tinctiirae Digitalis — Tincture of Digitalis (15 per cent.). 
— Dose, 5-20 minims (0.3-1.2 Cc). 

Unofficial Preparations. 

Digitalinum — Digitalini — Digitalin. — Description and Properties. — An amor- 
phous, yellowish-white, crystalline powder or scales, or light, white crystalline tufts of 
needles, odorless and of an intensely bitter taste. Insoluble in water, soluble in 
alcohol. 

Dose. — T -g-^~ jo grain (0.0006-0.002 Gm.). 

Digit6xin — Digit6xin — Digitoxin. — Description and Properties. — A white, crys- 
talline body, of a bitter taste ; insoluble in water, soluble in chloroform. 

Dose. — 2^o~T^o g ra ^ n (0.0003-0.0006 Gm.). 

Antagonists and Incompatibles. — The most complete antag- 
onist is saponine, the active constituent of Saponaria officinalis. 
The cardiac depressants antagonize the action of digitalis upon the 
heart, morphine and the emetics possessing a similar property, 
though in less degree. 

The incompatibles are the ferric chloride and sulphate, prepara- 
tions of cinchona, tannic acid and preparations containing it, and 
the subacetate and acetate of lead. 

, Synergists. — The cardiac action of digitalis is aided by other 
members of the group (cardiac stimulants), and also by belladonna 
and ergot. 

Physiological Action. — Externally and Locally. — Digitalis is at 
first irritant to the skin and mucous membrane. Later it may 
paralyze the sensory end-organs and thus prove an analgesic. 

Internally. — Digestive System. — Small doses ordinarily produce 
no effect upon the stomach. Large doses act as a gastro-intestinal 
irritant, exciting nausea, vomiting, and diarrhea. These effects may 
follow the prolonged administration even of small doses. 

Circulatory System. — The principal effects of digitalis are upon 
the circulatory apparatus, the action of the drug varying according 
to the size of the dose. Medicinal doses cause the pulse to beat 






CARDIAC STIMULANTS. 565 

stronger, firmer, and slower, the strength of the beat being due to 
stimulation of the cardiac ganglia and the muscular fibers them- 
selves. Arterial pressure is raised through stimulation of the vaso- 
motor center in the medulla and the ganglia situated in the mus- 
cular coats of the blood-vessels, causing a contraction both of the 
arteries and arterioles. 

This increase of arterial tension gives firmness to the pulse-beat : 
its slowness is due to lessened frequency in the heart-beat, caused 
by stimulation of both the roots and ends of the cardiac vagus, 
and consequent lengthening of the diastolic period. 

Large doses may cause the pulse to beat faster and still increase 
arterial pressure. The rapid cardiac action is due to over-stimula- 
tion of the heart muscle rather than to paralysis of the vagus. The 
arterial tension is still high, because the mechanism presiding over 
the caliber of the arterioles is not so easily overstimulated as the 
vagus, and contracts still more, which, with the increased action of 
the heart, tends to increase arterial tension. 

Toxic doses render the pulse very rapid, irregular, soft, and 
weak. The irregular action of the heart is due to exhaustion of 
the motor ganglia in the heart-muscle from over-stimulation, one 
of the functions of these ganglia being to induce regular cardiac 
contraction. 

The pulse is soft because of lowered arterial pressure, the 
arterioles under these doses being dilated from exhaustion of the 
vaso-motor mechanism. The weak pulse is due to exhaustion of 
the muscular power of the heart from over-stimulation. Death 
usually occurs with stoppage of the heart in diastole. 

Nervous System. — This is primarily and markedly stimulated. 
In small doses this action is limited to the medulla in the inhibitory 
cardiac and vasoconstrictor centers ; larger doses cause a more 
extended medullary excitation, with nausea and vomiting, convul- 
sions, and increased respirations ; toxic doses induce central motor 
convulsions, which are not due to cerebral anemia, since they may 
develop while the circulatory blood supply is ample. 

Respiratory System. — Medicinal doses have no effect upon the 
system ; toxic doses slow the respiration. 

Absorption and Elimination. — Digitalis is more rapidly absorbed 
than eliminated, the elimination probably taking place by the kid- 
neys, under certain conditions increasing the urinary flow, and many 
authorities claim that the amount of solids excreted is augmented, 
except urea and uric acid, which are diminished. 



5 66 



A TEXT-BOOK OF MATERIA MEDICA. 



Its diuretic action is due to the increase of blood-pressure in 
the glomeruli of the kidneys, being therefore more pronounced in 
conditions of low arterial pressure. Very large doses, instead of 
increasing the amount of urine, may diminish or even wholly 
suppress it. 

The action of digitalis upon the kidneys is elucidated by the 
diagram (Fig. 12). 

It is claimed that two constituents of digitalis, digitoxin and 
digitalein, dilate the renal arteries, while digitalin has no effect 
upon the renal blood-vessels, but contracts those of the general 
system. 

The true action of digitalis, however, is as yet undetermined. 
It is an extremely complex drug, and its various constituents pos- 
sess different properties when therapeutically employed. It is 
obvious, therefore, that the action upon the heart and kidneys will 
depend largely upon the particular preparation administered. 

Temperature. — Medicinal amounts have no appreciable effect 




Fig. i2.—^4, heart; B, veins; C, efferent vessels; D, artery; E, capillary system; F, afferent 
vessels ; G, kidney ; H, glomerules of the kidney. 

upon the temperature; large doses cause a reduction of bodily 
heat in febrile conditions, while toxic doses reduce temperature 
even in health. 

The action of digitalis upon the circulatory system is retarded 
by high temperature. 

Eye. — Medicinal amounts have no effect. Large or poisonous 
doses may cause dimness of vision, amblyopia, diplopia, or mydri- 
asis. In a case of poisoning by digitalis recorded by Jeanton there 
was xanthopsia for two days. 

Uterus. — Large doses stimulate contraction in the uterine 
muscles. 



CARDIAC STIMULANTS. 567 

Untoward Action. — Erysipelatous and papular eruptions have 
been produced by the drug, there having been also observed 
nausea and a feeling of weakness in the stomach, dimness of vision, 
headache, heaviness of the head, sleeplessness, and debility. 

Poisoning. — Toxic symptoms may occur either from the inges- 
tion of a single poisonous dose or the accumulation of the drug 
under prolonged administration. There are marked disturbances 
of the gastro-intestinal tract, abdominal pains, vomiting and 
purging, a rapid, irregular, and compressible pulse — often imper- 
ceptible at the wrist — and syncope, more frequently occurring 
when the patient is raised up. 

Other symptoms are — feeble respiration, dilated pupils and 
occasionally double vision, headache, delirium and stupor, and 
possibly convulsions just before death, which results from medullary 
excitation. Digitalis is not a rapid poison, the fatal collapse being 
usually deferred from ten to forty-eight hours. 

Treatment of Poisoning. — Lavage of the stomach should be 
immediate, emetics being too depressing if the heart is already 
affected by the poison. A solution of tannic acid should be intro- 
duced into the stomach as the best chemical antidote. Diffusible 
stimulants may be required, the horizontal position should be 
maintained, and external heat applied, particularly to the abdomen. 

Saponin, aconite, and opium are physiological antidotes, and 
one or more of them should be employed. 

Therapeutics. — Externally and Locally. — Poultices made of 
digitalis leaves have been employed with some success in acute 
inflammation of the joints, and when applied over the loins act as 
an efficient sedative and diuretic in congestion of the kidneys. 

Internally. — Digitalis is one of the most important drugs known 
to medicine. The remedy is indicated in deranged conditions of 
the circulatory system itself, and, moreover, where, although the cir- 
culatory mechanism be normal, an abnormal state of other organs 
may be improved by changing the circulation in them. Digitalis 
is indicated in any case where there is actual failure in the dynamic 
power of the heart-muscle, irrespective of the nature of any 
primary valvular lesion inducing the hyposystolic condition. 

Of course the rational use of the drug presupposes the absence 
of extensive fatty degeneration or interstitial myocarditis, since, 
should these conditions be advanced, there is danger of producing 
permanent asystole. It is difficult to estimate the integrity of the 
heart-muscle, and many cases presumably intolerant of the drug 
bear digitalis well. 



568 A TEXT-BOOK OF MATERIA MEDICA. 

There has been considerable objection to the use of digitalis 
in cardiac ataxia resulting from aortic regurgitation, on the ground 
that the latter action is more forcible and extensive under its 
influence. 

This argument is generally advanced by those who believe 
that the dilatation of the left ventricle in aortic regurgitation is 
due mainly to the effect of the counter-current upon the relaxed 
ventricle while in diastole. The regurgitant stream has probably 
little or no influence in producing the dilatation, since the cubic 
area of the ventricular cavity covered by the stream is so much 
greater than that of its inlet that it is difficult to see how great 
pressure could be exerted in this way. The phenomenon is, rather, 
mainly due to the greater pressure necessary to empty the ventricle 
of its superfluous blood. 

That there is any marked increase in the amount of regurgi- 
tated blood through reduced action of the heart is not sustained 
by the clinical results of the administration of digitalis in cases of 
aortic regurgitation. Indeed, they respond to the use of the drug 
as promptly as any other lesion, save that it is at times necessary 
to give larger doses, often twice the quantity administered in other 
valvular lesions. 

As to the cumulative effect of digitalis, so much feared by the 
older writers on its action, the evil may be ascribed to improperly 
selected cases or faulty administration. Under proper conditions 
the drug may be given for months without ill effect. 

It is asserted that the action of digitalis may be manifested for 
some time upon discontinuance of a brief dosage. 

With regard to the specific effect of the drug upon the heart- 
muscle this is not true, since the influence of the drug lasts but 
a few days, indirectly, through the additional muscle-power devel- 
oped during a few weeks' administration. During or after middle 
life, if the vascular tension be increased, and especially if there be 
any sclerosis of the vessels, the administration of digitalis should 
be combined with that of vaso-dilators, to prevent contraction of 
the vessels and consequent increase of peripheral resistance. Of 
these adjuncts, opium is generally the most useful, from 2 to 5 
drops (0.1-0.3 Cc.) of the deodorized tincture or -fa to -^ grain 
(0.003-0.005 Gm.) of morphine sulphate being given (Patton). 

In mitral regurgitation digitalis is an exceedingly efficient rem- 
edy. As shown in the diagram (Fig. 13), there is a deficiency of 
blood in the systemic arteries, and consequently an over-accumula- 



CARD J AC STIMULANTS. 



569 



tion in the pulmonary vessels and systemic veins. Owing to this 
venous hyperemia, there is congestion of the lungs, stomach, liver, 
and the entire digestive tract, together with the attendant symp- 
toms — dyspnea, bronchitis, deranged digestion, constipation, edema, 
etc. 

Digitalis by improving the pumping power of the heart equalizes 
the circulation, fills the systemic arteries, and relieves the venous 
congestion with its accompanying symptoms. 

Digitalis is valueless in the presence of compensatory hyper- 
trophy, but after dilatatio7i occurs is wonderfully effective, the size 
of the heart being often perceptibly diminished by a proper admin- 
istration of the drug. 

Digitalis may act indirectly as a tonic by improving the nutri- 
tion of the heart through the prolonged diastole and contraction 
of the cardiac muscle it occasions. The longer the period of dia- 
stole, the more time is allowed for the coronary arteries to fill and 
nourish the heart by the better blood-supply. The increased arte- 
rial tension produced by the 
drug causes the blood to be 
sent into the coronary arteries 
with greater force during the 
cardiac diastole. 

The forcible contraction of 
the heart occasioned by this 
drug expels the blood from 
the veins of the cardiac mus- 
cle, improved nutrition of the 
muscle resulting from this me- 
chanical action. 

The prolonged diastole pro- 
duced by digitalis allows the 
heart to rest, conserving its 
energy and rendering the drug 
of great value in many acute 
diseases accompanied by ex- 
cessive cardiac action. 

In many valvular diseases 
of the heart there is marked 
irregularity, an irritability in its action being often more serious 
than the mere leakage of blood. Digitalis by stimulating the 
vagus and motor ganglia reduces the irritative influence, causing 




Fig. 13. — Diagram showing how digitalis relieves 
the symptoms of mitral disease: 1, right heart; 2 
left heart; 3, lungs; 4, systemic arteries; 5, capil- 
laries: 6, systemic veins; 7, liver; 8, intestines; 
9, lymphatics. 



570 A TEXT-BOOK OF MATERIA MEDICA. 

the heart to beat more regularly. The drug is therefore of great 
service in exophthalmic goiter. 

In any condition of low arterial tension, whether resulting from 
hemorrhage, general debility, or whatever cause, digitalis by increas- 
ing the force of the heart and raising arterial pressure serves a 
useful purpose. 

In collapse from shock, poisoning, or cholera, where the great 
veins are dilated, it has proved an efficient agent. 

The functional activity of the various organs in anemia and 
other deranged conditions of the system may be improved by the 
administration of this remedy. 

The circulation being improved, there is increased absorption 
of fluid from the tissues, as well as greater circulation of fresh 
intercellular fluid, favoring combustion and functional activity, 
while the waste products are more readily removed. This action 
renders digitalis valuable as a tonic. 

In the second stage of pneumonia it is of the greatest importance, 
being of use here to stimulate the contractile force of the cardiac 
muscle when the intraventricular pressure becomes stronger than 
the unaided muscle can resist, and dilatation is imminent if not 
already begun. The main indication for the drug is the increase in 
intensity of the second pulmonic sound. 

Maragliano recommends the neutralization of the pneumococcus 
toxin by large doses of digitalis. On the first day the patient 
receives 4 Gm. of digitalis in an infusion, and if the case is a 
severe one this may be repeated in the second twenty-four hours. 
This dose is diminished with the pulse-frequency. Usually 12-16 
Gm. are necessary in the course of a pneumonia. While these 
large doses are well borne by pneumonia cases, they are injurious 
to well persons, due to a neutralization of the pneumonia toxin by 
the digitalis, for the addition of \\ Cgm. of digitalin to 10 Gm. of a 
culture kills the pneumococci. Even the addition of 3 Mg. to 10 
Gm. of the medium hinders their development. This action seems 
to be specific, since the growth of other organisms, as the typhoid 
or cholera bacilli, or the streptococcus pyogenes, is uninfluenced. 

In congestion of the lungs during the course of exhausting fevers, 
such as typhoid, and in the first stage of meningitis, bronchitis, cellu- 
litis, etc. before transudation takes place, it is considered by many 
physicians to be a valuable remedy in relieving the venous stasis. 

Digitalis is singularly beneficial in scarlet fever to slow the 



CARDIAC STIMULANTS. 571 

heart and by its action upon the kidneys prevent renal com- 
plications. 

Mr. Jones was among the first to recommend large doses of 
digitalis in delirium tremens. The author has found it to be won- 
derfully effective in this condition, particularly where there is low 
arterial pressure, at the same time having observed that smaller or 
stimulant doses are more beneficial than the larger ones suggested 
by Jones. The drug is undoubtedly less serviceable in delirium 
tremens characterized by high arterial tension. 

Digitalis has been successfully employed in acute mania and 
epilepsy, Gowers recommending it in the latter disease as an adju- 
vant to the bromides, associated with belladonna. It is fair to 
state that in maniacal conditions the preponderance of testimony is 
in favor of large doses — J to 4 fluidrachms (1.8-15. Cc.) of the 
tincture. 

Through its action in contracting the caliber of the arterioles 
digitalis serves as a valuable hemostatic in hemoptysis, epistaxis, 
menorrhagia, etc. 

The drug is thought to enhance the influence of ergot in post- 
partum hemorrhage, and when associated with iron it is of value in 
purpura hcemorrhagica. 

According to Harold Henry, digitalis and strychnine have 
proved beneficial in the diarrhea complicating remittent fever. 

The drug, combined with ergot or potassium bromide according 
to the indications, has been successfully employed in spermatorrhea 
and nocturnal emissions. 

It is said that absorption of pleuritic effusion is hastened by the 
continued administration of digitalis. 

Clifford Allbutt recommends it in sufficient doses to reduce the 
pulse to 45 or 50 in aneurysm. This method of treatment, how- 
ever, has not been widely adopted. 

Digitalis is one of the best antidotes to aconite- and muscarine- 
poisoning. 

The remedy is invaluable as a diuretic to relieve cardiac or renal 
dropsy, its efficiency being more apparent in the former variety, 
although acute renal dropsy usually yields to its influence. Should 
the renal structure be impaired, the drug is less serviceable, al- 
though, when combined with other appropriate remedies, it is 
decidedly beneficial in chronic Bright 's disease with cardiac dilata- 
tion. In the early stages of the malady, accompanied by cardiac 



572 A TEXT-BOOK OF MA TERIA MEDICA. 

hypertrophy and high arterial tension, it is doubtful whether 
digitalis is indicated, either alone or in combination. 

In conclusion, it should be stated that digitalis is recommended 
by all authors in every valvular disease of the heart, with the pos- 
sible exception of aortic regurgitation, some writers supposing it to 
be harmful in this condition because of the prolonged diastole it 
occasions. 

The author's experience leads him to differ with those who con- 
sider aortic insufficiency a contraindication to the use of this 
important drug. The excellent and logical reasons advanced by 
Professor Patton for the use of the remedy in aortic regurgitation 
coincide entirely with the author's views. t 

Contraindications. — Digitalis should not be given when there 
is marked degeneration of the heart-muscle or of the arterial 
walls. In simple hypertrophy, apoplexy, high arterial pressure, 
or vascular excitement the use of the drug is inadvisable. Many 
physicians regard aneurysm as a contraindication to the use of 
digitalis. 

Administration. — Any of the official preparations may be given, 
or the powdered leaves in pills or capsules — not at too frequent 
intervals, however, from four to eight hours elapsing between the 
doses, lest the drug accumulate in the system, producing poisonous 
symptoms. 

When digitalis has been administered for some time to a patient 
suffering from ascites, and the fluid is removed by paracentesis, 
poisoning may ensue. It is well, therefore, to discontinue the 
remedy for two or three days before tapping the patient. 

The rapidity of the drug's action upon the heart depends upon 
the presence or absence of a febrile state. The stimulant action 
upon the heart is usually observable in from twenty-four to thirty- 
six hours. The effects of the drug commonly continue from three 
to seven days after its discontinuance. 

The powdered digitalis, though the most irritant to the stom- 
ach, fully represents the drug, which is true of none of the prepa- 
rations. 

Of the active constituents, digitalin is usually preferred, notwith- 
standing its uncertain action. 

The infusion of digitalis, being an aqueous preparation and con- 
taining, therefore, a larger proportion of digitonin, is superior for 
diuretic purposes ; while the alcoholic preparations, like the fluid 
extract and tincture, being richer in digitalin and digitalein, are 
preferable when an action upon the heart is desired. 



CARDIAC STIMULANTS. 573 

Ordinarily, therefore, digitalis should be given in solution, the 
tincture and infusion being the most reliable preparations ; care 
being taken in the selection of the crude drug upon the character 
of which the strength of the preparation depends. 

In uncomplicated cases of cardiac failure, the result of valvular 
lesion, the tincture is most eligible. In cardiac failure associated 
with, or resulting from, kidney lesions the infusion, combined with 
some other diuretic, should be used. 



Strophanthus— Strophanthi— Strophanthus. 

U.S.I>. 

Origin. — The seed of Strophanthus hispidus D. C, deprived of 
its long awn. The plant is a woody climber, ascending to the tops 
of high trees, from which it hangs in festoons. It is found in 
tropical Africa, where it is used to prepare an arrow-poison termed 
kombi. 

Description and Properties. — The seeds are about f inch 
(15 Mm.) long and \ to \ inch (4-5 Mm.) broad, oblong-lanceolate, 
flattened and obtusely-edged, grayish-green, covered with appressed 
silky hairs, one side extending into the attenuated, pointed end ; 
kernel white and oily, consisting of a straight embryo having two 
cotyledons, and surrounded by a thin layer of perisperm ; nearly 
inodorous ; taste very bitter. 

Strophanthus contains a glucosid, strophanthine upon which its 
medicinal properties depend. It also contains kombic acid. Another 
active principle, ouabain, is obtained from a similar species of 
Strophanthus. 

Official Preparations. 

Tinctura Strophanthi — Tincturae Strophanthi — Tincture of Strophanthus 

(5 per cent.). — Dose, 2-10 minims (0.12-0.6 Cc). 

Unofficial Preparations. 

Strophanthin — Strophanthin — Strophanthin. Origin. — A glucosid obtained 
from the seeds of several species of Strophanthus, chiefly from Strophanthus hispidus. 

Description and Properties. — A white, amorphous or crystalline powder, of an acid- 
ulous, intensely bitter taste ; soluble in water and in alcohol. 

Dose. — T ^ 7 to -^ grain (0.0006-0.001 Gm.). 

Ouabain — Ouabain — Ouabain. — Origin. — A glucosid obtained from Acokan- 
thera ouabaio and Strophanthus glabrus. 

Description and Properties. — A white, transparent, crystalline powder, inodorous 
and 0/ a slightly bitter taste. Soluble in hot water, sparingly soluble in cold water, 
insoluble in alcohol. 

Dose. — Tfo-Q to 3 ^ grain (0.000032-0.00012 Gm.). 



574 A TEXT-BOOK OF MATERIA MEDICA. 

Antagonists and Incompatibles. — Probably the same as for 
digitalis. 

Synergists. — Digitalis, spartein, adonidin, etc. 

Physiological Action. — Externally and Locally. — The tincture 
of strophanthus has no local action of importance. Strophanthin 
and ouabain, however, possess marked sedative properties, the 
latter being much the stronger. They paralyze the ends of the 
sensory nerves and are powerful local anesthetics, in this respect 
surpassing even cocaine in their influence upon the cornea, the 
anesthesia produced by the glucosids being of much longer dura- 
tion than that caused by cocaine. 

These substances apparently have no action upon the central 
nervous system. 

Externally. — Digestive System. — Strophanthus is similar in its 
action to digitalis, though less apt to disturb digestion in small 
doses ; on the contrary, its bitter taste tends to improve the 
appetite. 

Circulatory System. — Upon the heart its action is identical with 
that of digitalis, though differing from the latter drug in its effect 
upon arterial tension and the arterioles. Strophanthus does not 
contract the arterioles and the arterial pressure is but slightly 
raised, the elevation being due to the increased force of the heart, 
toxic doses paralyzing it in systole. 

Nervous System. — Strophanthus affects the nervous system even 
less than digitalis. Poisonous doses, while not influencing the 
motor nerves so much as digitalis, act as a direct muscle-poison. 

Respiratory System. — It has no important action. 

Absorption and Elimination. — Strophanthus is rapidly absorbed, 
and more readily eliminated than digitalis, possessing no cumulative 
action. It is principally excreted by the kidneys, increasing the 
amount of urine by the strengthened heart's action. Unlike digi- 
talis, the drug has no influence upon the caliber of the renal 
vessels. 

Temperature. — Very large doses of strophanthus cause a slight 
reduction of temperature, not, however, to the extent of digitalis. 

Eye. — Excessive doses contract the pupil and increase intra- 
ocular tension. 

Uterus. — It resembles digitalis, though more feeble in its action 
upon the uterus. 

The symptoms and treatment of Poisoning are similar to those 
described under Digitalis, although strophanthus is more apt to 
occasion diarrhea. 



CARDIAC STIMULANTS. 575 

Therapeutics. — Externally and Locally. — Strophanthin has 
been occasionally employed as a local anesthetic, but the testimony 
in its favor is hardly sufficient to encourage its use. 

Internally. — Strophanthus is a cardiac remedy, being indicated 
in the same varieties of heart disease as digitalis. It is of particular 
value in stenosis of the mitral orifice, having a happy influence in 
controlling the irregular rhythm, nervous dyspnea, and intermittent 
pains distinctive of this lesion. The drug is also well adapted in 
subduing functional irregularities of rhythm in cases of irritable or 
tobacco heart. 

Theoretically, strophanthus is superior to digitalis in certain 
stages of Bright 's disease and heart failure of elderly people with 
slightly degenerated arteries. 

Shoemaker advocates the use of strophanthus in the treatment 
of psoriasis. 

While in the majority of cardiac diseases digitalis should be 
first tried, where it fails strophanthus is the proper recourse. It is 
a peculiarly efficient drug in the cardiac diseases of children, accord- 
ing to the majority of observers being safer than digitalis for young 
patients. 

Strophanthin has been used hypodermically with some success 
for the relief of chills due to malaria, shock, or nervousness. 

Dr. Gemmell and other observers claim that ouabain in doses of from y^uu t0 shs 
grain (0.00006-0.00003 Gm.) greatly reduces the number and severity of the paroxysms 
in whooping cough. 

Contraindications. — The same as for digitalis. 

Administration. — Of the preparations of strophanthus, the 
tincture is preferable, both for convenience and safety. Should 
strophanthin or ouabain be desirable, a solution is to be pre- 
ferred. 

Adonis Vernalis— Adonidis Vernalis— False Helle- 
bore. 

(Pheasant's Eye.) 

Origin. — A perennial herb attaining a height of about 10 inches 
(25 Cm.), indigenous in Europe. 

Description and Properties. — It has but little odor and a some- 
what acrid and bitter taste. The plant contains a glucosid, adoni- 
din, to which it owes its medicinal properties. This constituent is 
a light-colored, crystalline powder, of a bitter taste and soluble in 
water and alcohol. 



576 A TEXT-BOOK OF MATERIA MEDICA. 

Dose of Adonidin. ^ \ grain (0.003-0.01 Gm.). 

Antagonists, Incompatibles, and Synergists. — The same as 
for digitalis. 

Physiological Action and Therapeutics. — The action of adoni- 
din is similar to that of digitalis, although more nearly resembling 
that of digitalin, save that it is not cumulative. 

It is used for the same purposes as digitalis, being peculiarly 
valuable in relieving the pains of heart disease, and is by some 
physicians preferred to digitalis in the treatment of aortic and mitral 
insufficiency, cardiac asthma, and functional irregularity of the heart. 

Convallaria— Convallariae— Convallaria. U. S. T. 

(Lily of the Valley.) 

Origin. — The rhizome and roots of Convallaria majalis L., a 
stemless perennial indigenous in Europe, Northern Asia, and North 
America. 

Description and Properties. — Of horizontal growth and some- 
what branched, about \ inch (3 Mm.) thick, cylindrical, wrinkled, 
whitish, marked with a few circular scars ; at the annulate joint with 
about eight or ten thin roots ; fracture somewhat fibrous, white ; 
odor peculiar, pleasant ; taste sweetish, bitter, and somewhat acrid. 

Convallaria contains two glucosids : convallamarin, the cardiac- 
acting principle ; and convallarin, an emeto-cathartic principle. 

Official Preparations. 

ExtrSctum Convallariae Fluidum — Extracti Convallariae Fluidi — Fluid Ex- 
tract of Convallaria.— Dose, 15-30 minims (1-2 Cc). 

Unofficial Preparations. 

Extractum Convallariae— Extratcti Convallariae— Extract of Convallaria. — 
Dose, 5-15 grains (0.3-1.0 Cc). 

Infiisum Convallariae — Infusi Convallariae — Infusion of Convallaria. — Dose, 
\-2 ounces (15-60 Cc.) (25 parts in 75 parts of water). 

Convallamarinum — Convallamarini — Convallamarin. — Description and 
Properties. — A whitish-brown, amorphous powder, soluble in water and alcohol. 

Dose. — \-2. grains (0.016-0.12 Gm.). 

Convallarinum — Convallarini — Convallarin. — Description and Properties. — A 
crystalline body insoluble in water, soluble in alcohol. 

Dose. — 2-4 grains (0.12-0.24 Gm.). 

Antagonists and Incompatibles. — The antagonists are the 
same as for digitalis ; tannic acid precipitates the convallamarin. 

Synergists. — The cardiac stimulants enhance its cardiac action ; 
emetics and cathartics aid its emeto-cathartic effects. 



CARDIAC STIMULANTS. S77 

Physiological Action. — Almost identical with that of digitalis, 
but less powerful and possessing no cumulative action. Prepara- 
tions free from convallarin do not disturb the stomach nor affect 
the cerebro-spinal functions. It is asserted that convallaria has 
stronger diuretic properties than digitalis. 

Convallamarin in some cases has produced, among other un- 
toward symptoms, hemoptysis and dyspnea. 

Convallarin is a drastic purgative, and in full doses occasions 
nausea and gastric pain. 

Therapeutics. — Convallaria is used for the same purposes ex- 
actly as digitalis. The only advantage it possesses over the latter 
drug is that it has no cumulative action. By some physicians it is 
considered superior to digitalis as a diuretic and cardiac stimulant 
after failure of compensation, the diuresis it occasions persisting for 
some time after the withdrawal of the drug. 

It has been employed with some benefit in various forms of 
neuralgia, and has even been recommended to calm the restlessness 
and relieve the insomnia of fever. 

Contraindications. — The same as for digitalis. 

Administration. — The fluid extract is the best preparation to 
use, although the infusion is highly recommended by many physi- 
cians. 

In addition to digitalis, strophanthus, adonis, and convallaria, 
there are a number of very similar bodies that have like actions 
found in a variety of plants. Among these are squills, helleborus 
niger, apocynum cannabinum, acokanthera, and erythrophlceum. 
These contain glycosides that are closely related to those in the 
plants just treated. 

Others of the cardiac stimulant group have very dissimilar 
actions, and though compared with digitalis, such comparisons are 
to be taken on superficial resemblance only, not on inherent simi- 
larity of physiological action. 

Scoparius— Scoparii— Scoparius. XT. S. I>. 

(Broom.) 

Origin. — The tops of Cytisus scoparius L., a shrub 3 to 6 feet 
(.9-1.8 M.) high, found in Western Siberia and the greater part of 
Europe. It is sometimes cultivated, and is occasionally met with 
wild in some of the Middle and Southern States. 

Description and Properties. — Occurring in thin, flexible, 

37 



578 A TEXT-BOOK OF MATERIA MEDIC A. 

branched twigs, pentangular, winged, dark green, nearly smooth, 
tough, usually free from leaves ; odor peculiar when bruised ; taste 
disagreeably bitter. 

The constituents of scoparius are an oily, bitter substance, spar- 
teine, a cardiac stimulant, and a neutral, crystalline principle, scopa- 
rin, to which the diuretic action of the drug is due. 

Dose. — -|— i drachm (2.0-4.0 Cc), in infusion. 

Official Preparations. 

Extr&ctum Scoparii Fluidum — Extr&cti Scoparii Fluidi— Fluid Extract of 
Scoparius. — Dose, y 2 -\ fluidrachm (2.0-4.0 Cc). 

Spartelnae Siilphas — Sparteinae Sulphatis — Sparteine Sulphate. — The neu- 
tral sulphate obtained from the alkaloid sparteine. 

Description and Properties. — Colorless, white, prismatic crystals, or a granular 
powder, odorless, and having a slightly saline and somewhat bitter taste; liable to 
attract moisture when exposed to damp air; very soluble in water and alcohol. 

Dose. — 2V -2 g rams (0.003-0.1 Gm.J. 

Unofficial Preparation. 

Scoparine — Scoparine — Scoparine. — Description and Properties. — Amorphous 
or in small crystals, of a pale-yellow color, inodorous and tasteless. 
Dose. — 1-15 grains (0.06-1.0 Gm.), as a diuretic. 



Antagonists and Incompatibles. — The antagonists are the 
same as for digitalis, and tannic acid and potassium iodide are 
incompatibles. 

Synergists. — Digitalis, strophanthus, adonidin, etc. 

Physiological Action. — Externally and Locally. — No action 
-observed. 

Internally. — Digestive System. — Sparteine sulphate acts like bit- 
ters in improving the appetite and digestion. Large doses, as with 
digitalis, produce vomiting and purging. 

Circulatory System. — Cushing and Matthews claim that the 
action of sparteine upon the heart and blood-vessels is similar to 
that of digitalis ; but numerous experiments upon animals show 
that the drug has no action upon these organs. Notwithstanding 
the results of the pharmacological experiments above referred to, 
the author has observed that, clinically, the drug is similar in its 
action to that of digitalis, save that it is not so powerful, but more 
rapid, though the arterioles are not contracted as is the case with 
digitalis. 

Nervous System. — Sparteine resembles coniine rather than digi- 



CARDIAC STIMULANTS. 579 

talis in its action upon the nervous system, depressing the brain 
and spinal cord, and lowering reflex action through paralysis of 
the motor nerve- endings. Under toxic doses there is also extreme 
muscular weakness, often complete paralysis. 

Respiratory System. — Medicinal doses produce no effect. Toxic 
doses slow and weaken the respiration, death being possible from 
paralysis of the respiratory center. 

Absorption and Elimination. — It is rapidly absorbed and as read- 
ily eliminated, and, unlike digitalis, has no cumulative action. 
In disease it is an active diuretic, particularly the infusion or fluid 
extract or the alkaloid scoparin. Sparteine, on the other hand, is 
not an active diuretic. 

Scoparius therefore increases the flow of urine and the excre- 
tion of urea. The drug has a direct action upon the renal struc- 
ture. 

Poisoning. — The following symptoms occur : Small, rapid, and 
irregular pulse, dyspnea, great muscular weakness, incoordination 
of movement, and muscular tremors, followed possibly by clonic 
and tonic convulsions, which are replaced by marked depression 
of the nervous and muscular systems, and collapse, death usually 
resulting from paralysis of the respiratory center. 

Treatment of Poisoning. — The respiration should be stimulated 
by hypodermic injections of strychnine and atropine. It may even 
be necessary to apply electricity over the vagi or practise artificial 
respiration. Potassium iodide or solutions of tannic acid should 
be given, and the free use of diuretics or diluents to favor elim- 
ination. 

Therapeutics. — Externally and Locally. — No influence is ex- 
erted. 

Internally. — Scoparius is used for the same purposes as digi- 
talis. It is particularly serviceable in some cases of nephritis with 
weak, irregular heart-action, and in chronic Bright' s disease with 
cardiac hypertrophy and high arterial tension. It is also useful in 
the nervous, irregular heart of opium habitues. 

Sparteine sulphate has been recommended in paralysis agi- 
tans and asthma. Like strophanthus, it is of more value in mitral 
than in other valvular diseases. 

For some reason scoparius is generally less esteemed than 
digitalis, although, while competent clinicians consider it of minor 
importance as a cardiac remedy, the drug is not without enthusi- 
astic advocates among those of authority. 



580 A TEXT-BOOK OF MATERIA MEDICA. 

Contraindications. — Practically the same as for digitalis, though 
less definite. 

Administration. — The fluid extract of scoparius may be given, 
or the decoction, "made by adding \ an ounce (16.0 Gm.) of the 
broom-tops to 1 pint (J liter) of water and boiling them down to 
\ pint (250 Cc). Of this 1 ounce (32.0 Cc.) should be taken 
every three hours. This decoction is one of the most efficient 
diuretics in cardiac dropsy " (Hare). 

The sparteine sulphate is usually employed when an action on 
the heart is desired : it may be administered either hypodermically, 
in pill, capsule, or aqueous solution. 

Cactus— Cacti— Cactus. 

(Night-blooming Cereus.) 

Origin. — The stems and flowers of Cactus grandiflorus L., 
a plant indigenous in tropical America and frequently cultivated 
for ornament. 

Preparations. 

Extractum Cacti Fluidum— Extracti Cacti Fluidi— Fluid Extract of Cac- 
tus. — Dose, 5-10 minims (0.3-0.6 Cc). 

Tinctura Cacti — Tincturae C&cti — Tincture of Cactus. — Dose, 15-20 minims 

(1.-1.2 Cc). 

Physiological Action and Therapeutics. — Cactus differs from 
digitalis in its less disturbing influence upon the digestive appa- 
ratus. 

Its action upon the circulation is to elevate arterial pressure and 
increase the strength and rapidity of the heart's action when given 
in medicinal doses. Toxic doses, on the contrary, diminish both 
the blood-pressure and the pulse-rate, rendering the heart irregular 
in its action and arresting it in systole. Moreover, the reflexes are 
increased by poisonous doses, death being preceded by clonic and 
tetanic convulsions of spinal origin. 

The knowledge of this drug is mainly derived from advertising 
pamphlets. The studies of Sharp and Hoseason make it probable 
that it has very little action or therapeutic utility. 

Therapeutically, cactus probably possesses no advantages over 
digitalis. It has, however, been highly recommended by certain 
physicians in myocarditis, aortic regurgitation, functional disorders 
of the heart, severe arrhythmia, angina pectoris, and cardiac weak- 
ness following typhoid fever. 



CARDIAC STIMULANTS. 581 

Dr. Wilcox considers mitral stenosis a contraindication to its 
use. It is asserted that it produces no cumulative effects or 
untoward symptoms. 

Caffeina— Caffeinae— Caffeine. U. S. I>. 

Origin. — A feebly basic, proximate principle obtained from the 
dried leaves of Thea Sinensis (tea) L., or from the dried seeds of 
Coffea Arabica (coffee) L., and found also in other plants. 

It may also be prepared synthetically from theobromine by the 
introduction of a third methyl group. 

Description and Properties. — Fleecy masses of long, flexible, 
white crystals, having a silky luster, without odor and of a bitter 
taste ; permanent in the air ; soluble in 80 parts of water and 
33 parts of alcohol. 

Dose. — 2-5 grains (0.12-0.3 Gm.). 

Official Preparations. 

Caffeina Citrata — Caffeinae Citratae — Caffeine Citrate. — Description and 
Properties. — A white powder, odorless, having a purely acid taste and an acid 
reaction. I part of citrated caffeine forms a clear, syrupy solution with about 3 parts 
of water. 

Dose. — 2-5 grains (o. 1 2-0. 3 Gm.). 

Caffeina Citrata EffervSscens — Caffeinae Citratae Effervescentis— Efferves- 
cent Citrated Caffeine. — Dose, 1-4 drachms (4.0-16.0 Gm.). 

Allied Compounds. 

Guaranine. — The alkaloid obtained from the seeds of Paullinia ctipana. 

Theine. — An alkaloid obtained from tea. 

Theobromine. — An alkaloid obtained from cacao seeds. 

Sodio-theobromine Salicylate (Diuretin). — An active diuretic described under 
the group "Diuretics." 

Guaranine, theine, and theobromine, while chemically almost identical with caffe- 
ine, differ from it somewhat in their physiological action. 

Guaranine depresses first the sensory and afterward the motor nerves, affecting 
them from the center toward the periphery. Its primary effect in toxic doses is to pro- 
duce general hyperesthesia, succeeded by convulsions of spinal origin. 

Theine in its action very closely resembles guaranine, save that when injected it 
causes local anesthesia. It lowers the temperature, while caffeine tends to raise bodily 
heat. 

Theobromine differs in no essential from caffeine, save that it is a better diuretic. 

Antagonists and Incompatibles. — Cerebral and cardiac de- 
pressants antagonize the action of caffeine. 

Synergists. — Members of this group and the Cerebral and 
Motor Excitants. The action of caffeine upon the digestive tract 
may be enhanced by the vegetable bitters. 



582 A TEXT-BOOK OF MATERIA MEDICA. 

Physiological Action. — Externally and Locally. — Caffeine pos- 
sesses no very important local action, though freshly roasted coffee 
is slightly analgesic and deodorant — a property due to the empy- 
reumatic oils developed by roasting rather than to the caffeine 
which it contains. 

Internally. — Digestive System. — In moderate amounts caffeine, 
like tea and coffee, stimulates the appetite, improving the digestion, 
and relieving the sense of plenitude in the stomach. All of them 
increase peristalsis and (particularly coffee) act as mild laxatives 
and slightly stimulate the secretion of bile. 

Immoderate and continued dosage of caffeine or the excessive 
use of tea and coffee profoundly disturbs the digestive function, 
resulting in gastric catarrh, indigestion, hepatic congestion, consti- 
pation, and hemorrhoids. 

Circulatory System. — Medicinal doses of caffeine strengthen and 
quicken the heart's action. The rapidity of the heart's action is 
increased, shortening the diastolic period, the drug in this respect 
differing from digitalis ; at the same time the arterial pressure is 
elevated. 

The precise modus operandi of caffeine in its action upon the 
circulatory system is still a disputed question, some investigators 
claiming that its whole and only influence proceeds from a direct 
stimulation of the heart-muscle, while others consider its action to 
be upon the nervous system. So far as relates to arterial pressure, 
the preponderance of testimony seems to prove that the tension 
is raised independently of any action on the vaso-motor centers. 
Excessive doses depress the heart, causing an irregular, slow, and 
weak pulse. 

Nervous System. — The drug is a decided cerebral excitant, stim- 
ulating the mental function, occasioning wakefulness, and under 
large doses producing hallucinations and delirium. 

There is a marked difference between the effects upon the brain 
caused by caffeine and those occasioned by opium. The former 
renders the reasoning and imaginative powers more acute, enabling 
the person to perform increased and prolonged mental work. 
Moreover, the cerebral excitation caused by caffeine is not suc- 
ceeded by mental depression and sleep ; while opium occasions 
an incoordination of mental activity, the brain being incapable of 
performing active practical and physiological work, and the reason- 
ing powers rendered subservient to the imaginative. The opium 
habitue thus becomes a visionary, his mental powers inclining more 



CARDIAC STIMULANTS. 583 

to revery than to action. The primary excitation induced by the 
drug, however, is soon succeeded by lethargy and sleep. 
• The moderate use of tea or coffee increases muscular endu- 
rance ; large doses, on the other hand, occasion muscular trem- 
bling and marked weakness. Excessive doses lessen the activity 
of the spinal reflex centers. In moderate amounts coffee possesses 
some aphrodisiac action. 

Respiratory System. — Medicinal doses slightly stimulate, while 
toxic doses depress, the respiration. 

Absorption and Elimination. — Caffeine is freely absorbed, and is 
chiefly eliminated by the kidneys, a portion being oxidized in the 
body. The primary effect of the drug upon the kidneys is to 
diminish the blood-supply to the kidneys, thereby lessening the 
amount of urine. At the same time the drug has a direct stimu- 
lating action upon the secreting structure of the kidney, and if its 
effect upon the vaso-motor center is not too marked its general 
action is that of a diuretic. 

Ordinarily, caffeine lessens tissue-waste; the elimination of urea, 
however, is not uniform, being in some cases increased and in others 
diminished. 

Temperature. — Under large doses of the drug the temperature 
is slightly elevated, the result of combined increase of heat-pro- 
duction and heat-dissipation. Toxic doses first raise and then 
depress temperature. 

Eye. — Strong solutions of caffeine applied to the cornea act as 
a mild mydriatic and anesthetic. Hutchinson records a case of 
amblyopia produced by the drug. 

U?itoward Action. — Caffeine occasionally causes marked cere- 
bral congestion, insomnia, and embarrassment of respiration, while 
the untoward effects of an immoderate use of coffee are described 
by Guilliot {Nat. Disp., p. 363) as follows : 

" The skin is pale or dusky, the expression is dull, and the 
features have the look of premature old age, and sometimes are 
slightly swollen. The flesh wastes, the eyes have a glassy look, 
the pupils are dilated, the lips and tongue are tremulous ; the 
appetite is lost ; there is insomnia or else disturbed sleep ; dyspep- 
sia accompanies constipation or diarrhea ; neuralgia affects the 
stomach and other parts ; headache and vertigo are common, and 
spasms or general convulsions may occur." According to the 
same writer, " habitual excess of coffee induces in men sexual 



584 A TEXT-BOOK OF MATERIA MEDICA. 

apathy and impotence, and in women leucorrhea, Sometimes it 
produces pruritus ani aut vulva" 

Poisoning. — A case has been reported by Liell where 18 grains 
(1.16 Gm.) of citrated caffeine taken by a woman were in an hour 
and a half accompanied by the following symptoms : 

" Delirium, semi-consciousness, absence of headache, pulse 55 
and irregular, cold extremities and general clammy perspiration, 
normal temperature (?), anesthesia, slight paresis of hands, feet, 
and tongue, and a reeling gait. Convulsions followed of a teta- 
noid character ; the pupils were normal, the vision dim ; some 
vomiting took place ; there was abdominal colic, but no opening 
of the bowels ; and urination was frequent and copious." 

Treatment of Poisoning. — This should include the use of emetics 
and eliminants, together with diffusible stimulants and the applica- 
tion of external heat. 

Therapeutics. — Externally and Locally. — Burning coffee in a 
room deodorizes the air. Powdered coffee is used to disguise the 
offensive odor of iodoform, and is frequently associated with it in 
the form of an ointment in the treatment of aural eczema. Equal 
portions of pulverized coffee and boric acid have been recom- 
mended by Guerder as an insufflation in whooping-cough. 

Internally. — The chief value of caffeine is as a diuretic and 
cardiac stimulant, being peculiarly useful in cases of senile cardi- 
opathies associated with nephritis, in which, from degeneration of 
the heart-muscle, digitalis is not well tolerated. 

In some instances the primary effect of caffeine is to increase 
the pulse-rate ; usually, however, if the remedy be adapted to the 
case, there is a secondary slowing of the heart's action. The drug 
is considered by some physicians to be superior to digitalis as a 
cardiac stimulant in valvular disease accompanied by fatty heart. 
It is an efficient remedy to counteract the cardiac depression in low 
fevers, and is a comparatively safe drug in myocarditis. 

It is a remarkably efficacious remedy in cardiac and renal 
dropsy and to remove pleuritic effusion, etc. 

Caffeine cannot displace digitalis as a heart tonic, but as diuretics 
the xanthin derivatives, caffeine and theobromine, are excellent. 
Theobromine is the better diuretic of the two. They both act as 
stimulants to the kidney epithelium, and contrasted with the saline 
diuretics, which increase the elimination of inorganic salts, the 
xanthin derivatives aid in the elimination of nitrogenous substances, 
notably urea and uric acid. 



CARDIAC STIMULANTS. 585 

Its action upon the digestive system renders caffeine of great 
value as a stomachic tonic. Migraine, due either to gastric catarrh 
or nervousness, frequently yields to this drug. 

Its value in the treatment of headaches may be enhanced by 
administering it together with antipyrine or sodium bromide. 

Choleraic diarrhea, the result of nervous depression, is often 
markedly benefited by citrated caffeine. It has also been used 
with some success in the diarrhea of phthisis. 

Sodio-benzoate of caffeine in doses of 5 to io grains (0.32- 
0.64 Gm.) is considered by Misrachi to be superior to ergot in 
post-partum hemorrhage. Caffeine possesses a considerable repu- 
tation as a remedy for asthma. 

It is a matter of frequent observation that strong coffee cer- 
tainly modifies the effects of alcoholic intoxication. Hiccough is 
often relieved by coffee. 

Caffeine or strong coffee has unquestionably proved valuable 
in the reduction of strangulated hernias after taxis has failed. 

The medical uses of caffeine would be incomplete without 
mention of its extreme value in opium-poisoning . Here a salt of 
caffeine may be used hypodermically or a strong infusion of coffee 
given by the mouth or rectum. 

Contraindications. — Ordinarily, caffeine is contraindicated in 
acute inflammations, particularly of the kidneys. 

Administration. — The alkaloid may be given by the stomach, 
but when hypodermic medication is desired caffeine is unavailable, 
a fresh salt for hypodermic use being properly employed, made by 
combining caffeine with salicylic acid, cinnamic acid, or sodium 
benzoate. The latter salt — sodio-benzoate of caffeine — is probably 
the most eligible and contains 45 per cent, of caffeine. 

The citrated caffeine should be given in pills, capsules, or 
tablets ; the effervescent citrate, in water. 

A valerianate of caffeine is prepared which has been employed 
with success, it is asserted, in hysterical vomiting and whooping 
cough in doses of from \ to 2 grains (0.03-0.12 Gm.). 

Strong coffee serves as a most excellent substitute for the alka- 
loid, and may be given by the mouth or as an enema. 

Alcohol— Alcoholis— Alcohol. U. S. P. 

Origin. — A liquid composed of about 91 per cent, by weight or 
94 per cent, by volume of Ethyl Alcohol, and about 9 per cent, by 
weight of Water. 



586 A TEXT-BOOK OF MATERIA MEDIC A. 

Description and Properties. — A transparent, colorless, mobile, 
and volatile liquid, of a characteristic, rather agreeable odor, and a 
burning taste. Miscible with water, ether, or chloroform in all pro- 
portions. It is inflammable, and readily volatilized even at low 
temperatures. Alcohol should be kept in well-closed vessels, in a 
cool place, remote from lights or fire. 

Official Preparation. 

Alcohol Dilutum — Alcoholis Diluti — Diluted Alcohol. — A liquid composed 
of about 41 per cent, by weight, or about 48.6 per cent, by volume, of absolute Ethyl 
Alcohol, and about 59 per cent, by weight of Water. It should be kept in well-closed 
vessels, in a cool place, remote from lights or fire. 

Alcohol Absolutum— Alcoholis Absoluti— Absolute 
AlcohoL ?7.#.jP. 

Origin. — Ethyl Alcohol, containing not more than 1 per cent, 
by weight of Water. 

Description and Properties. — A transparent, colorless, mobile, 
and volatile liquid, of a characteristic, rather agreeable odor, and a 
burning taste. Very hygroscopic. It should be kept in well- 
stoppered bottles or tin cans, in a cool place, remote from lights or 
fire. 

Alcohol Deodoratum— Alcoholis Deodorati— De- 
odorized AlcohoL U. S. JP. 

Origin. — A liquid composed of about 92.5 per cent, by weight, 
or 95.1 per cent, by volume, of Ethyl Alcohol, and about 7.5 per 
cent, by weight of Water. 

Description and Properties. — As given and described under 
Absolute Alcohol. 

Spiritus VIni Gallici— Spiritus VIni Gallici— Brandy. 

77. 8. I*. 

Origin. — An alcoholic liquid obtained by the distillation of the 
fermented, unmodified juice of fresh grapes, and at least four years 
old. 

Description and Properties. — A pale amber-colored liquid, 
having a distinctive odor and taste and a slightly acid reaction. Its 
specific gravity should not be more than 0.941, nor less than 0.925, 
corresponding, approximately, to an alcoholic strength of 39 to 47 
per cent, by weight or 46 to 55 per cent, by volume. 



CARDIAC STIMULANTS. 587 

Splritus Frumenti— SpTritus Frumenti— Whiskey. 

U. S. P. 

Origin. — An alcoholic liquid obtained by the distillation of the 
mash of fermented grain — usually mixtures of Corn, Wheat, and 
Rye — and at least two years old. 

Description and Properties. — An amber-colored liquid, having 
a distinctive odor and taste, and a slightly acid reaction. Its 
specific gravity should not be more than 0.930 nor less than 0.917, 
corresponding, approximately, to an alcoholic strength of 44 to 50 
per cent, by weight or 50 to 58 per cent, by volume. 

Vinum Album— VTni AIbi— White Wine. U. S. J>. 

Origin. — An alcoholic liquid made by fermenting the juice of 
fresh grapes, the fruit of Vitis vinifera (nat. ord. Vitacece), freed from 
seeds, stems, and skins. 

Description and Properties. — A pale amber-colored or straw- 
colored liquid, having a pleasant odor, free from yeastiness, and a 
fruity, agreeable, slightly spirituous taste, without excessive sweet- 
ness or acidity. It should contain not less than 10 nor more than 
14 per cent, by weight — equivalent to 12.4 to 17.3 per cent, by 
volume — of absolute alcohol. 

Vinum RGbrum— VTni RGbri— Red Wine. TJ. S. P. 

Origin. — An alcoholic liquid made by fermenting the juice of 
fresh, colored grapes, together with their skins. 

Description and Properties. — A deep red liquid, having a 
pleasant odor, free from yeastiness, and a fruity, moderately astrin- 
gent, pleasant, and slightly acidulous taste, without excessive sweet- 
ness or acidity. It should contain not less than 10 nor more than 
14 per cent, by weight — equivalent to 12.4 to 17.3 per cent, by 
volume — of absolute alcohol. 

Unofficial Alcoholic Preparations. 

Spiritus Rectificatus — Splritus Rectificati — Rectified Spirit contains 85 per 
cent, by weight of absolute alcohol. 

Proof Spirit contains 49 per cent, by weight of absolute alcohol, together with a 
peculiar volatile oil and other foreign material. 

Gin is usually distilled in Holland from rye or barley, and flavored with juniper ber- 
ries and hops. It contains about 42 per cent, by weight of absolute alcohol, and is 
probably more diuretic than other liquors because of the oil of juniper it contains. 

Rum is obtained by distilling fermented molasses, having about the same alcoholic 
strength as gin. 



588 A TEXT-BOOK OF MATERIA MEDICA. 

Port Wine is prepared by adding spirit during the process of manufacture, bring- 
ing the alcoholic strength up to 30 or 40 per cent. 

Sherry Wine is a dry wine, having from 20 to 35 per cent, of alcohol. 

Sparkling Wines contain from 8 to 10 per cent, of alcohol. They are more or 
less sweet wines, and are charged with carbonic acid, being bottled before fermentation 
is completed, the grape-sugar, in consequence, not undergoing conversion into alcohol, 
The sparkling wines are Champagne, Hock, and Sparkling Catawba. 

Sweet Wines are those in which the sugar has not all been converted into alcohol, 
the alcoholic strength being therefore relatively low — from 6 to 7 per cent. Among the 
sweet wines may be classed Angelica, Madeira, Malaga, Muscatel, Tokay, etc. 

Dry Acid Wines are those in which the fermentation is complete, the alcoholic 
strength varying from 5 to 7 per cent. They are such as California Hock, Ohio and 
Kelly Island Catawba, Rhine and Moselle wines, Hochheimer, Diirkheimer, Deides- 
heimer, etc. 

Light Red Wines contain 5 to 7 per cent, of alcohol, and are astringent, contain- 
ing tannic acid and the coloring matter of the grape. They are Claret, Red Rhine, 
Concord, Hungarian, etc. 

Beer, Ale, and Porter are prepared by fermenting malted grain with hops and 
adding other bitters. Beer contains from 2 to 3 per cent, of alcohol ; ale and porter, 
from 4 to 6 per cent., besides carbonic and lactic acids, malt extract, various aromatics, 
and potassium and sodium salts. 



Antagonists and. Incompatibles. — The motor, cerebral, and 
cardiac depressants are antagonistic to moderate amounts of alcohol. 

Synergists. — The motor excitants, atropine, ether, and the dif- 
fusible stimulants. 

Physiological Action. — Few drugs have occasioned such di- 
versity of opinion regarding their physiological action and uses as 
alcohol. With those who — as Nathaniel asked, " Can any good 
thing come out of Nazareth ?" — question whether any benefit can 
accrue from alcohol, being honestly convinced that the drug pos- 
sesses no value in medicine, the author begs leave to take respect- 
ful yet decided issue. Indeed, extensive reading, experimentation, 
and clinical experience have alike proved to him conclusively that 
we have in alcohol a drug endued with peculiar and invaluable 
properties, rendering its efficacy inferior to that of no remedy in the 
range of materia medica. Like opium and other powerful agents, 
the drug may prove noxious or beneficial according to the manner 
and judgment with which it is employed. 

The physiological action as here given agrees with the best 
authorities on the subject. 

Externally and Locally. — Alcohol is a powerful antiseptic and 
disinfectant. It possesses also rubefacient, astringent, and anhi- 
drotic properties. When applied in full strength to the skin it pro- 
duces a sensation of coldness, due to rapid evaporation. Should 



CARDIAC STIMULANTS. 589 

the drug be diluted, the sensation of cold is greatly diminished. 
If evaporation be prevented, the effect is that of heat or burning, 
owing to the penetration of the drug through the epidermis and its 
chemical influence upon the tissues beneath. 

Its effect upon mucous membranes is similar to that upon the 
skin, save that the former are more readily affected. The mucous 
membrane becomes whitened and corrugated, because of the coagu- 
lation of albumin and the abstraction of water. The white film, 
which is the precipitated albumin, later disappears as the albu- 
min is redissolved in liquids present, although the prolonged action 
of alcohol upon mucous membranes produces a permanent co- 
agulation. 

When the drug is applied to the skin the secretion of sweat is 
lessened and the cutaneous blood-vessels contracted. 

Internally. — Digestive System. — The local action upon the mu- 
cous membrane of the mouth is as above described. There is a 
burning sensation, and marked increase of saliva due entirely to 
reflex action. When ingested a sense of warmth is experienced in 
the stomach, the blood-vessels of which are dilated, with accom- 
panying increase in the secretion of gastric juice, as well as stimu- 
lation of peristaltic action. As a consequence, moderate amounts 
of the drug, when taken before meals, improve the appetite and 
favor digestion : if taken during the active period of digestion, the 
process is retarded. 

It will be observed that the action of alcohol upon the digestive 
system is quite similar to that of vegetable bitters, immoderate 
amounts checking the flow of gastric juice and increasing the secre- 
tion of mucus, producing a catarrhal condition ; while excessive 
doses or the daily and intemperate use of the drug frequently 
occasions nausea and vomiting. 

Upon the intestines alcohol acts as an astringent, brandy being 
an efficient agent in checking diarrhea. Small amounts of the 
drug act as an hepatic stimulant, while large quantities change the 
character of the bile, at the same time lessening its amount. 

Circulatory System. — Taken into the stomach, alcohol reflexly 
and rapidly stimulates the heart before absorption can take place, 
the effect upon the circulation persisting after the drug is absorbed. 
Cardiac action is rendered more rapid and forcible, probably by 
stimulation of the heart-muscle, as well as of the accelerator 
center in the medulla. Arterial tension is raised, although the 
blood-vessels are dilated, especially those of the skin, owing 
to the depression of the vaso-motor center located in the ves- 



590 A TEXT-BOOK OF MATERIA MEDICA. 

sel-walls. Toxic doses depress the heart and still further dilate 
the arterioles, greatly lowering the blood-pressure. This action 
of alcohol, in causing the heart to beat stronger and faster, at 
the same time dilating the blood-vessels — particularly those of 
the peripheries — renders the drug one of the most valuable dif- 
fusible stimulants. 

Excessive doses of alcohol greatly depress or paralyze the 
heart, while an enormous amount, when taken upon an empty 
stomach, by reflex action occasioning cardiac paralysis, may pro- 
duce instantaneous collapse. 

The ameboid movements of the white blood-corpuscles are tem- 
porarily increased, though subsequently diminished. The function 
of the red corpuscles is impaired, preventing the oxyhemoglobin 
from parting with its oxygen, consequently retarding oxidation in 
the tissues. It is a matter of observation that persons addicted to 
the habitual use of alcohol are frequently obese, on account of the 
imperfect combustion of fat and its consequent accumulation in the 
tissues. 

Experiments have conclusively shown that moderate amounts 
of alcohol are oxidized during their circulation in the body. Alco- 
hol must, then, serve as a food to a certain extent. Indeed, experi- 
ments have irrefutably proved that the body-weight of an animal 
may be maintained for a considerable period upon alcohol alone. 
This peculiar and apparently paradoxical property, of lessening 
and at the same time undergoing oxidation, renders the drug of 
eminent value in certain conditions. 

Nervous System. — Moderate amounts of alcohol stimulate the 
nervous system, particularly the brain, chiefly through the increased 
supply of blood to the parts, although the drug probably exerts 
some influence also upon the nerve-cells. The highest nerve- 
centers are first affected, so that a person who has taken alcohol 
displays a keener intelligence, a brighter wit, and possesses a sense 
of general mental and physical power. Should the dose have been 
large, depression is wont to succeed the feeling of exaltation, the 
functions in general sharing in the change, which passes from the 
highest to the lowest centers in regular succession, the order of 
functional disturbance being that of the cerebrum, cerebellum, 
spinal cord, and, lastly, the medulla oblongata. 

It will be observed that in this descending scale of functional 
derangement the mental faculties, being the highest, are earliest 
affected, resulting in failure of coordination in reasoning power 
and loss of control in the logical sequence of ideas, although the 



CARDIAC STIMULANTS. 591 

imagination, the emotions, and the- faculty of speech may still re- 
tain their normal energy and exercise. Soon, however, the will- 
power succumbs ; the emotions, while yet stimulated, are no longer 
subject to mental command ; the imagination becomes disordered ; 
and the patient laughs and weeps hysterically, and, as a final result 
accompanying this stage of intoxication, the power of speech is 
merged in spasmodic, incoherent, or almost inaudible utterances 
or perhaps total dumbness. 

The muscular system, being less highly organized, may still 
retain its activity ; yet it at last yields to the influence of the poi- 
son, the movements becoming wholly incoordinate, until the patient 
sinks into a condition of drowsy, helpless stupor, in which he is 
incapable of the slightest effort dependent upon muscular energy. 

Consequent to this stage is the influence upon the spinal cord, 
the reflex centers in which are abolished, the patient micturating 
and defecating involuntarily. Meanwhile the respiratory center, 
hitherto unaffected, shares the general influence of the drug. The 
breathing is difficult, or even paralyzed, and the face livid. At 
length the cardiac movements are involved, and, the paralysis 
affecting its functions — at first stimulated — fatal collapse ensues. 

A frequent phenomenon incident to the depression of the reflex 
centers is found in the fact that injuries which under normal condi- 
tions might prove fatal to the subject have little or no effect upon 
the system saturated with alcohol, the heart and respiratory appa- 
ratus being for the time immune against reflex action. 

Respiratory System. — Medicinal amounts deepen and accelerate 
respiration ; large doses render the breathing slow and shallow, — 
these effects being due to stimulation or depression of the respira- 
tory center. Death from a toxic dose of alcohol usually results 
from paralysis of respiration. It may be noted that under toxic 
dosage of the drug the amount of carbonic acid exhaled is dimin- 
ished. 

Absorption and Elimination. — Alcohol is very rapidly absorbed, 
and " eliminated unchanged in small proportion to the quantity in- 
gested," owing to the fact that the greater proportion of it is oxi- 
dized in the body. The kidneys, lungs, skin, and liver share in 
the excretory process. 

The quantity of urine is greatly increased, principally on account 
of increased arterial pressure, although the amount of urea, sodium 
chloride, and uric, phosphoric, and sulphuric acids in the urine is 
diminished by alcohol. 

When taken internally the amount of sweat is slightly increased, 



59^ A TEXT-BOOK OF MATERIA MEDIC A. 

due partly to a direct stimulation of the sweat-glands, and partly 
to the dilatation of the cutaneous blood-vessels. 

Temperature. — Alcohol is an antipyretic of considerable power. 
This action is owing (i) to lessening of tissue-oxidation ; (2) to the 
cooling of the blood through dilatation of the cutaneous blood- 
vessels, subjecting the warm blood from the interior of the body 
to the cooling influence of the atmosphere ; (3) to the cooling of 
the surface of the body from the evaporation of sweat. The power 
to resist cold is diminished by the habitual use of alcohol. The 
drug would be useful in stimulating warmth in a person who had 
been long exposed to cold, but only in a warm room. Then, by 
rapidly dilating the blood-vessels of the skin and allowing the 
blood to flow to the surface, the subject is favorably affected by 
the external heat, while there is less danger of congestion in some 
internal organ. 

Eye. — The excessive use of alcohol may produce amblyopia, 
watery eyes, and congested conjunctivae. 

Untoward Action is fully described under " Poisoning." 

Poisoning. — The untoward or poisonous action of alcohol may 
be divided into what are known as Acute and Chronic Alcoholism. 
The former has been described in detail under the effect of alcohol 
upon the Nervous System, and doubtless most readers are too 
familiar, from observation, with the effects of alcoholic intoxi- 
cation to require further enlightenment as to its general phe- 
nomena. 

A serious and altogether too frequent accompaniment of acute 
alcoholism is delirium tremens, the symptoms of which are as fol- 
lows : The malady is usually announced by marked anorexia, 
insomnia, and restlessness ; tremor, especially of the tongue ; dis- 
orders of vision and hearing ; great mental depression ; a soft 
and weak pulse ; and cold extremities. These manifestations are 
succeeded in a day or two by active delirium, even passing into 
wild mania and horrible hallucinations, in which the distorted 
imagination conjures up the most loathsome images of reptiles, 
the vivid spectacle of which preys upon the mind with pitiable 
terror and dismay. Even the tenderest offices in behalf of the 
sufferer are perverted by the disordered reason, which becomes 
possessed only with the sentiment of abject, agonizing fear. 

The muscles are in a constant tremor, and the patient talks in- 
cessantly and incoherently. The pulse is usually rapid, feeble, and 
dicrotic, and insomnia is continuous. The patient may even pass 
into a state of coma-vigil, which is generally the precursor of death, 



CARDIAC STIMULANTS. 593 

or fatal collapse may occur suddenly and unexpectedly. In other 
cases the sufferer may relapse into a sound sleep, when the delirium 
subsides and convalescence is established. 

It should be observed that alcoholic coma may be confounded 
with uremic coma, apoplexy, opium-narcosis, sunstroke, epileptic 
coma, or asphyxia. 

Diabetic or hysterical coma may also be confounded with alco- 
holic coma. So far as the odor of the breath is concerned, it is not 
pathognomonic, since a person in a comatose condition from other 
causes may have previously taken sufficient alcohol to impart to 
the breath a distinct odor of the drug. 

It is often, in fact, extremely difficult to make a positive diagno- 
sis of true alcoholic coma. It may sometimes happen that the 
patient is suffering from the combined action of alcohol and opium 
or noxious gases, or that he has been seized with cerebral hemor- 
rhage or sunstroke. 

Chronic alcoholism is generally the result of the continuous and 
excessive use of alcohol. The symptoms vary according to the 
individual case. There maybe (i) the moderate, daily drinker; 
(2) the periodical inebriate, usually the highly gifted, sensitive, and 
sympathetic, who drinks to excess at certain distinct intervals with 
a deliberation and moral perversity expressed by the declaration of 
a noted British general : " By the blessing of God, I intend to get 
gloriously drunk next Saturday night ;" (3) the immoderate, im- 
pulsive, maniacal inebriate, who, during his usually brief existence 
after the establishment of the disease, is subject to constant and 
excessive indulgence, incapacitating him from the simplest duties 
of a rational life. 

The habitual drinker sooner or later suffers from disturbed 
digestion, gastric catarrh, and irregularity of the bowels ; his face 
is usually puffed and bloated, while the capillaries, especially of the 
cheeks and nose, become permanently dilated, marked acne rosacea 
not infrequently developing in the latter organ. 

The excessive use of alcohol predisposes the subject to cirrhosis 
of the liver, other conditions being arterio-sclerosis, fatty degenera- 
tion of the heart and liver, paralysis, peripheral neuritis, Bright's 
disease, amaurosis, ataxia, epilepsy, insanity, etc. 

Treatment of Acute Alcoholic Poisoning. — The stomach should 
be emptied of all unabsorbed alcohol ; cautious inhalations of am- 
monia should be given, accompanied by the internal administration 
of the aromatic spirit of ammonia and black coffee. Capsicum and 
vinegar also have the power to stimulate the patient and counteract 

38 



594 A TEXT-BOOK OF MA TERIA MEDICA. 

the ill effects of alcohol, while it is said that ammonium chloride, 
in a dose of 30 grains (2.0 Gm.) given in 8 ounces (236.59 Cc.) of 
water, is an exceedingly efficient antagonist. 

Should there be great depression of respiration, faradism of the 
muscles of respiration may be necessary, with warm applications to 
the extremities and cold to the head. Hot milk and other forms 
of nutritious liquid food form an essential element in the restoration 
of the patient. 

Treatment of Delirium Tremens. — The management of this phase 
of alcoholism requires great skill and judgment, the student being 
referred for details to any standard work on the Practice of Medi- 
cine. The indications are to quiet the patient and sustain his 
physical strength. This has been accomplished by the adminis- 
tration of chloral and potassium bromide or opium, these drugs, 
together with digitalis, strychnine, and other cardiac stimulants, 
having proved highly efficient remedies. Gastric sedatives may be 
required, such as bismuth, carbolic acid, hydrocyanic acid, etc. 

Nutritious and easily digested food should be given, and, in case 
of gastric intolerance, enemata should be adopted. 

Treatment of Chronic Alcoholism. — A thoughtful and extended 
experience with inebriates has convinced the author that the great 
majority of dipsomaniacs suffer from a disease possessing usually 
a distinct and traceable etiology and resulting from either inher- 
ited or acquired neurosis. In many cases the malady is charac- 
terized by uniform development, progress, symptomatology, and 
termination. 

The author makes this statement with the full knowledge that 
he will be regarded as a " sentimentalist " by many professedly 
" practical " men. Yet a careful scrutiny of numerous cases and a 
consideration of the means adopted in the treatment of them will, 
he believes, convince the thoughtful physician that he has to deal 
with a thoroughly diseased organism rather than with the victim 
of a " vicious drug habit " readily overcome by a moderate exercise 
of the will. 

The medicinal agents most serviceable in the treatment of 
chronic alcoholism are strychnine^ atropine, small doses of the 
alteratives, arsenic, potassium iodide, and mercury, while phos- 
phorus and other restoratives and tonics will frequently be found 
useful. 

The hygienic surroundings should be of the best, and the treat- 
ment should include a nutritious, non-stimulating diet taken with 



CARDIAC STIMULANTS. 595 

regularity, and the free use of fruits and vegetables. Close atten- 
tion should be paid to the condition of the bowels and skin, and, 
among other remedial influences, should be mentioned laxatives 
when necessary, frequent Turkish baths, and, above all, change of 
scene and engaging mental occupation. 

From time to time various drugs have been heralded as specifics 
in the treatment of alcoholism, certain " cures " (sic) acquiring an 
influence among the ignorant and unscientific wholly at variance 
with the therapeutic value of these vaunted remedies. It is super- 
fluous to say that to a skilled and enlightened professional judg- 
ment the rationale of intemperance and the agents serving to miti- 
gate the malady present a problem far too complicated to be 
grasped by the empirical understanding, operating even under the 
most ingenuous motives. 

Therapeutics. — Externally and Locally . — Alcohol is an efficient 
application for contusio?is, sprains, and indolent ulcers, and is also 
serviceable in hardening the skin and preventing the formation of 
bed-sores. It is a useful hemostatic to check capillary oozing, and, 
being a powerful antiseptic, is available in all wounds. Uterine 
hemorrhage is controlled by inserting in the cavity of the uterus a 
tampon saturated with the drug. 

Its local anesthetic properties render alcohol valuable in relieving 
irritation of the skin in urticaria, frost-bite , etc. ; it also serves as an 
efficient gargle in diphtheria and acute pharyngitis. 

Alcohol, or brandy, has been successfully employed to harden 
nipples and prevent their cracking. 

A very efficient means of reducing temperature in fever is to 
bathe the skin with alcohol, the method being also useful to check 
excessive sweating. 

The absorption of inflammatory exudates may be aided and the 
pain of muscular rheumatism relieved by rubbing the affected area 
with tincture of camphor or soap liniment, both of which con- 
tain alcohol. 

Internally. — Alcohol, in the form of wine, beer, or ale, taken 
before or during meals, is an efficient stomachic. Atonic dyspepsia 
and the weakened digestio?i attendant upon convalescence from acute 
diseases are greatly benefited by some form of alcohol. When 
digestion becomes impaired as the result of physical or mental 
exhaustion the drug serves a useful purpose as a tonic. 

The wisdom of using the drug, however, in the above condi- 
tions may be questioned, because of the danger of establishing the 



596 A TEXT-BOOK OF MATERIA MEDICA. 

desire or habit, particularly in the case of neurotic women and 
those whose debilitated energies call for renewed and increasing- 
quantities of the drug. 

Frequently the physical or mental depression, the peculiar, irre- 
sistible craving for stimulants, the insomnia and fitful appetite and 
disposition which urge recourse to alcoholic indulgence, are but 
the early manifestations of a brain-and-nerve degeneration, the 
impulse to drink being only the physical demand for relief. 

There is less danger attending the administration of alcohol in 
conditions of lowered vitality and weakened digestion in old people 
than in the young and middle-aged. The drug is decidedly contra- 
indicated in persons of average health and fair digestion, although 
beneficial in the aged, whose powers are failing from natural 
decline. 

The anesthetic and sedative properties of alcohol, especially in 
the form of champagne, which contains carbon-dioxide gas, may 
frequently control obstinate vomiting. Gastralgia and the pain 
arising from flatulence are often readily relieved by brandy, and 
the same remedy may be used efficiently in checking simple 
diarrhea. 

As a pure cardiac stimulant, alcohol is remarkably serviceable 
in syncope, asphyxia, exhausting hemorrhages, diphtheria, and col- 
lapse where death seems imminent. In counteracting the effects 
of narcotic poisons it is almost indispensable ; it is, moreover, un- 
doubtedly the most efficient antidote to the poison of venomous 
reptiles. 

It is a common practice with some surgeons to precede the 
inhalation of chloroform with the administration of I or 2 ounces 
(30.0-60.0 Cc.) of whiskey or brandy, for the twofold purpose of 
sustaining the heart and prolonging the anesthesia. 

In certain stages of various acute diseases, such as typhoid, 
typhus, small-pox, pneumonia, cerebrospinal 7neningitis, capillary 
bronchitis, etc., alcohol is one of the most potent and valuable rem- 
edies. It should be employed in these cases only when there is 
marked depression of the circulatory apparatus, characterized by 
a weak, rapid, soft, and irregular pulse, with a feeble sound of the 
heart and threatened syncope or delirium. 

Alcohol is beneficial in such cases as the foregoing when by 
its use the tongue is moistened, the pulse and respiration is slowed, 
the restlessness and delirium quieted, and the skin becomes less 
parched. 



CARDIAC STIMULANTS. 597 

Should the drug increase the pulse and intensify the nervous 
manifestations, it is an indication that the dosage is excessive, in 
which event it may be well to discontinue the administration alto- 
gether. Even where the action of the drug is favorable, it is 
doubtful whether it should ever be given in fevers throughout the 
twenty-four hours, administration being advisable rather when the 
muffled or absent first sound of the heart indicates impending cardiac 
failure. This usually occurs during the interval between midnight 
and 7 a.m. Stimulation should therefore begin before midnight, 
and full doses — say I fluidounce (30 Cc.) — be given every three 
hours, full doses being of more service than repeated smaller 
amounts. 

It should be remembered that alcohol generates no new energy, 
but simply enables a person to utilize in a short period all his 
available reserve force. The utmost discrimination and judgment 
are requisite to the proper administration of the drug. 

In pyemia, septicemia, erysipelas, and diphtheria alcohol is fre- 
quently one of our most efficient remedies, while clinical experi- 
ence has fully demonstrated its value in retarding the progress of 
phthisis. Tubercular patients acquire a marked tolerance for the 
drug, being often able to assimilate enormous quantities without 
deleterious results. 

Small quantities of alcohol appear to exert a favorable action 
in functional impotence. 

Its sedative action, or possibly its property of increasing intra- 
cranial blood-pressure, renders alcohol valuable as a hypnotic in 
neurasthenia. 

A very common remedy for anemia and chlorosis is red 
wine. 

Acute coryza or a cold may often be wholly aborted by taking 
a good quantity of hot whiskey or hot " gin sling" upon retiring. 

The statement made by so prominent a physician as Mr. Law- 
son Tait, " I am fully persuaded, after thirty years of life as hard 
in work and as full of responsibility as well could be, that the mod- 
erate use of alcohol is a necessity in our modern life," is, in the 
author's opinion, too strong. Physicians, of all men, should realize 
the ill effects of over-work, as well as those of alcohol. Is it not 
wiser to limit the amount of labor than to attempt undue exertion 
under the stimulus of so seductive and dangerous a drug? Sta- 
tistics show that of those addicted to the excessive use of alcohol 
and other pernicious drugs, by far the largest percentage is among 



59 8 A TEXT-BOOK OF MATERIA MEDICA. 

physicians — a sad commentary on their wisdom and professional 
knowledge. 

Contraindications. — Alcohol should not be given when the 
urine is of high specific gravity. It is ordinarily contraindicated 
in nephritis and diseases of the liver, gout, gleet, gonorrhea, and 
urethritis. The malt liquors and sweet wines should not be given 
in diabetes nor to persons suffering from eczema. Alcohol is also 
dangerous in hypertrophy of the heart and excessive cardiac 
action. 

Administration. — When possible, alcohol should always be 
taken with food. Brandy is the best astringent, and brandy and 
champagne are the best preparations to allay nausea. Whiskey is 
the least constipating, and gin the most diuretic. As regards 
their sedative action, there is no preference, whichever is most 
agreeable to the patient and least affects the head being advisable. 
As stomachics either claret, beer, or ale is most efficacious in im- 
proving the appetite. In cases of fermentative dyspepsia sweet 
wines and malted liquors are more injurious than beneficial, whiskey 
or brandy being preferable. 

When desired as diffusible stimulants in cases of cardiac failure 
brandy or whiskey only should be employed, which preparations 
may be given hypodermically. 



PREPARATIONS OF AMMONIUM. 

AquaAmmoniae Fortior— Aquae Ammoniae Fortioris 
—Stronger Ammonia Water. U. S. JP. 

Origin. — An aqueous solution of ammonia (NH 3 = 17.01), con- 
taining 28 per cent, by weight of the gas. 

Description and Properties. — A colorless, transparent liquid, 
having an excessively pungent odor and a very acrid and alkaline 
reaction. It should be kept in strong, glass-stoppered bottles. 

Dose. — 3-6 minims (0.18-0.3 Cc). 



Official Preparation. 

Spiritus Ammoniae — Spfritus Ammoniae — Spirit of Ammonia. — Origin. — 
An alcoholic solution of ammonia, containing 10 per cent, by weight of the gas. 

Description and Properties. — A colorless liquid, having a strong odor of ammonia 
and a specific gravity of about 0.810 at 15 C. (59 F.). It should be kept in glass- 
stoppered bottles, in a cool place. 

Dose. — 10-60 minims (0.6-3.7 Cc). 



CARDIAC STIMULANTS. 599 

Aqua Ammoniae— Aquae Ammoniae— Ammonia 
Water. U. S. 1>. 

Origin. — An aqueous solution of ammonia, containing 10 per 
cent, by weight of the gas. 

Description and Properties. — A colorless, transparent liquid, 
having a pungent odor, an acrid, alkaline taste, and a strongly 
alkaline reaction. It should be kept in glass-stoppered bottles, in 
a cool place. 

Dose. — 10-20 minims (0.6-1.2 Cc.) well diluted. 

Official Preparations. 

Linimfcntum Ammoniae — LinimSnti Ammoniae — Ammonia Liniment (Am- 
monia Water, 350; Alcohol, 50; Cotton-seed Oil, 600). — For external use. 

Splritus Ammoniae Aromatticus — Spiritus Ammoniae Aromaltici. See Am- 
moniuffi Carbonate. 

Ammonii Carbdnas— Ammonii Carbonatis— 
Ammonium Carbonate. U. S. P. 

Origin. — Prepared by subjecting to sublimation and resublima- 
tion a mixture of Ammonium Sulphate or Chloride and Calcium 
Carbonate. 

Description and Properties. — White, hard, translucent, striated 
masses, having a strongly ammoniacal odor without empyreuma, 
and a sharp, saline taste. On exposure to air the salt loses both 
ammonia and carbonic acid, becoming opaque, and is finally con- 
verted into friable, porous lumps or a white powder. Slowly but 
completely soluble in about 5 parts of water ; decomposed by hot 
water, with the elimination of carbonic acid and ammonia. 

Ammonium carbonate should be kept in well-stoppered bottles, 
in a cool place. 

Dose. — 2-15 grains (0.1 2-1.0 Gm.). 

Official Preparation. 

Spiritus Ammoniae Aromaucus— Spiritus Ammonias AromStici — Aromatic 
Spirit of Ammonia (Ammonium Carbonate, 34; Ammonia Water, 90; Oil of Nut- 
meg, 1 ; Oil of Lemon, 10 ; Alcohol, 700 ; Oil of Lavender Flowers, I ; Water, to 
make 1000). — Description and Properties. — A nearly colorless liquid when freshly pre- 
pared, but gradually acquiring a somewhat darker tint. It has a pungent, ammoniacal 
odor and taste. It should be kept in glass-stoppered bottles, in a cool place. 

Dose. — ]/ z -2 fluidrachms (1.8-7.3 Cc). 



Antagonists and Incompatibles. — The cardiac sedatives are 



600 A TEXT-BOOK OF MA TERIA MEDICA. 

antagonistic. The incompatibles are the vegetable and mineral 
acids, the earthy salts, lime water, and solutions of acidulous salts. 

Synergists. — Cardiac and diffusible stimulants, antispasmodics, 
and capsicum internally. The local action of ammonium prepara- 
tions is enhanced by cantharides and counter-irritants. 

Physiological Action. — Externally and Locally. — When solu- 
tions of ammonia are applied to the skin or mucous membranes 
they act as irritants, rubefacients, or vesicants according to the 
strength of the solution and the freedom or confinement of the 
vapor. 

When inhaled the vapor occasions great irritation of the respi- 
ratory passages, together with a sense of suffocation and spasmodic 
closure of the glottis. There are also produced marked irritation 
of the conjunctivae, lacrymation, and a watery secretion from the 
nose. 

Internally. — Digestive System. — Small doses act like alkalies 
upon the gastro-intestinal tract, augmenting the flow of gastric 
juice when given before meals and neutralizing it when given after 
meals. 

Excessive doses occasion violent and destructive inflammation 
of the mouth, esophagus, and stomach, possibly resulting in stric- 
ture of the esophagus and stenosis of the pyloric orifice. 

Circulatory System. — These preparations, whether ingested or 
injected into the system, cause a temporary fall of arterial pressure, 
quickly followed by a decided increase and acceleration of the pulse, 
owing to nervous stimulation of the heart. Their precise action 
upon the blood is not known, though they certainly lessen the 
oxygen-carrying power of the red corpuscles and diminish the 
tendency to coagulation of the blood. 

Nervous System. — Other than their action upon the sensory 
nerves when locally applied, these preparations affect the nervous 
system only in stimulating the motor centers of the spinal cord, 
excessive doses causing convulsions similar to strychnine. 

Respiratory System. — They stimulate the respiratory center, 
greatly increasing the number of respirations. 

Absorption and Elimination. — The preparations of ammonium 
are rapidly absorbed, being oxidized in the system and eliminated 
chiefly by the kidneys, increasing the acidity of the urine and aug- 
menting its amount, as well as increasing the proportion of nitric 
acid, uric acid, and urea excreted. The continued use of ammo- 
nium preparations therefore promotes tissue-waste. 



CARDIAC STIMULANTS. 601 

Temperature is unaffected by medicinal amounts. 

Poisoning. — In toxic doses these preparations are powerful cor- 
rosive poisons, exciting violent inflammation of the gastro-intestinal 
tract, labored respiration, great cardiac depression, muscular weak- 
ness, and possibly convulsions. 

Treatment of Poisoning. — Similar to that of poisoning by the 
corrosive alkalies — evacuation of the stomach, the internal admin- 
istration of vinegar or other vegetable acids, followed by oil and 
demulcent drinks, opium being indicated for the relief of pain. 

Therapeutics. — Aqua ammonia is a valuable ingredient of 
" hair tonics " in premature alopecia. The ammonia liniment is a 
favorite remedy for chilblains. 

The aromatic spirit of ammonia is of value in many diseases 
of the scalp, such as pityriasis, etc., and, when well diluted with 
water, has been recommended in acute pharyngitis. The ammonium 
carbonate possesses an action similar to that of salicylic acid in 
its property of dissolving epidermic scales, rendering it of value in 
preparing the skin for the subsequent local treatment of psoriasis. 

As a counter-irritant ammonia water — or, preferably, the am- 
monium liniment — is efficient in chronic rheumatism and joint 
affections. 

Ammonia water relieves the irritation caused by bites of insects ; 
its vapor inhaled acts as a rapid restorative in cases of fainting. 

Internally. — The ammonium preparations here mentioned are 
serviceable in lessening excessive acidity of the stomach. The 
aromatic spirit of ammonia is frequently beneficial in allaying 
the distress of nervous headache, and is also an efficient remedy to 
counteract the effects of an immoderate use of alcoholic stimulants, 
having proved in many cases valuable in the treatment of delirium 
tremens. 

The most important uses of these preparations are, perhaps, as 
powerful diffusible stimulants to the circulatory, respiratory, and 
spinal systems. They are of undoubted value in sudden cardiac 
failure arising from any cause, such as poisoning from chloroform, 
noxious gases, hydrocya?iic acid, etc. Taken internally or by intra- 
venous injection, they counteract the poisonous effects resulting 
from the bites of venomous reptiles. 

The carbonate is an excellent stimulant to sustain the heart 
and respiration during the course of pneumonia, eruptive and con- 
tinued fevers, etc. In all dynamic conditions of the heart this 
preparation should be given in small doses, frequently repeated. 



602 A TEXT-BOOK OF MATERIA MEDICA. 

The carbonate is also a valuable stimulant expectorant in chronic 
bronchitis and broncho-pneumonia. 

The preparations of ammonia have been recommended in 
threatened thrombosis. The condition being established, however, 
it should be noted that the method of treatment by intravenous 
injection, advocated by some authorities, is at best a very dubious 
procedure. 

Contraindications. — Acute gastritis and conditions of excessive 
acidity of the urine. Conditions of anemia and great emaciation 
would contraindicate the prolonged use of these preparations. 

Administration. — The liquid preparations should always be 
well diluted, and the carbonate should invariably be given in solu- 
tion. The fluid extract of glycyrrhiza disguises the taste very 
well. 

Owing to the rapid elimination of these drugs, the dosage 
should be frequently repeated. 



GROUP IX.— CARDIAC SEDATIVES. 

AconTtum— AconTti— Aconite. TJ. S. J\ 

Origin. — The tuber of Aconitum Napellus L., a plant about 
40 inches (1 M.) high, met with throughout the greater portion 
of Asia and Europe, mostly in mountainous regions. 

Description and Properties. — From f to f inch (10-20 Mm.) 
thick at the crown, and from 2 to 3 inches (50-75 Mm.) long, with 
scars or fragments of radicles ; dark brown externally, whitish in- 
ternally ; with a rather thick bark, the central axis about seven- 
rayed ; without odor, taste at first sweetish, soon becoming acrid, 
and producing a sensation of tingling and numbness lasting for 
some time. It contains an acrid alkaloid, aconitine. 

Dose. — \-2 grains (0.03-0.12 Gm.). 

Official Preparations. 

Extractum Aconiti — Extracti Aconiti— Extract of Aconite. — Dose, ^-\ 
grain (0.006-0.01 Gm.). 

Extr&ctum Aconiti Fluidum — Extracti Aconiti Fluidi — Fluid Extract of 
Aconite. — Dose, ^-2 minims (0.00.6-0.12 Cc). 

Tincttira Aconiti — Tinctiirae Aconiti — Tincture of Aconite. — Dose, ^-5 min- 
ims (0.008-0.3 Cc). 



CARDIAC SEDATIVES. 603 

Unofficial Preparation. 

Fleming's Tincture of Aconite is nearly twice as strong as the official tincture, 
the dose being correspondingly smaller. 

Aconitlna— Aconitlnae— Aconitine. (Unofficial.) 

Origin. — An alkaloid principle extracted from Aconite. 

Description and Properties. — The alkaloid exists in two forms K 
crystalline and amorphous ; white or yellowish-white, odorless, with 
a strong acrid taste characteristic of aconite. The crystalline form 
is soluble in alcohol, ether, and chloroform, and partially so in 
water. 

The alkaloid is one of the most powerful of poisons, rivalling in 
virulence hydrocyanic acid. The various aconitines are of different 
strengths, so that only the minimum dose of a new sample should 
at first be employed. 

Dose. — xoVo~2To g ram (0.00006-0.00025 Gm.). 

Oleatum Aconitlnae — Oleati Aconitlnae — Oleate of Aconite. — A 2 per cent. 

solution of Aconitine in Oleic Acid. For external use. 



Antagonists and Incompatibles. — Digitalis and other cardiac 
stimulants, including atropine and ether, antagonize the action of 
aconite. 

Synergists. — All members of this group and cold enhance the 
action of the drug. 

Physiological Action. — Externally and Locally. — Applied to 
mucous membranes or to the skin for any length of time, aconite 
first stimulates and then depresses the ends of the sensory nerves, 
producing respectively tingling, numbness, and local anesthesia. 

Internally. — Digestive System. — Except when given in very di- 
lute solutions, aconite produces tingling and numbness of the lips 
and mouth, with increased secretion from the salivary glands. 
Large doses cause great irritation, together with a sense of con- 
striction in the fauces. 

Under normal conditions of the stomach aconite may act upon 
that organ as a sedative, augmenting its secretions. Large doses 
may occasion pain, nausea, and vomiting. 

Circulatory System. — Aconite causes a marked slowing of the 
heart's action, due to stimulation of the vagus center in the me- 
dulla. Following the slowing of the heart, due to vagus action, 
aconite has a direct action on the heart-muscle, increasing its irri- 



604 A TEXT-BOOK OF MA TERIA MEDICA. 

lability, causing it to become very rapid and weak, eventually occa- 
sioning delirium cordis through overstimulation. Death may 
occur from cardiac paralysis, the heart being arrested in diastole. 
The arterioles are contracted, owing to stimulation of the vaso- 
motor center in the medulla ; but because of this action, occasion- 
ing a marked slowing of the heart, there is a great decrease of 
blood-pressure. Moreover, the contractive action of the vaso- 
motor center is somewhat counteracted by its primary stimulation 
of the cutaneous nerves, resulting in dilatation of the peripheral 
vessels and consequent flushing of the skin. 

Nervous System. — Excessive doses of aconite cause a slight 
stimulation of the sensory nerve-endings, finally followed by 
depression, the muscles passing into a state of paralysis, probably 
occasioned by direct action upon the muscle-tissue. 

Respiratory System. — The respiration is slowed by moderate 
doses ; under large doses it is rendered both shallow and slow. 
The breathing is retarded, -because the peripheral endings of the 
vagi distributed to the lungs are depressed. Under large doses 
there is depression of the respiratory center, paralysis of which 
is occasioned by lethal amounts. 

Absorption and Elimination. — Aconite is rapidly absorbed, but 
its channels of elimination are not definitely known, although it is 
probably excreted by the kidneys, and to some extent by the skin, 
the drug acting as a mild diaphoretic. 

Temperature. — Aconite is alleged to be a decided antipyretic, the 
reduction of temperature being due to various causes : (i) the slow- 
ing of the circulation, diminishing the metabolism ; (2) the peripheral 
action of aconite, causing dilatation of the cutaneous blood-vessels; 
(3) the depressing action of the drug upon all muscle-tissue. 

Eye. — Toxic amounts of the drug have produced mydriasis, 
misty vision, and diplopia. 

Untoward Action. — Besides the symptoms described under 
" Poisoning," there have been observed pustular and erythematous 
eruptions, vertigo, and dimness of vision. 

Poisoning. — The first effect of toxic doses is to cause marked 
tingling of the tongue and lips, which sensation soon extends to 
the fingers and may even affect the entire cutaneous surface. There 
is extreme muscular weakness, particularly noticeable in the lower 
extremities. The pulse, at first slow and weak, soon becomes rapid 
and almost imperceptible. The respirations are quite feeble and 
shallow, and there may be marked dyspnea. 



CARDIAC SEDATIVES. 605 

The countenance is anxious and the skin pallid, cold, and cov- 
ered with sweat, with great reduction of temperature. These symp- 
toms are accompanied by dimness of vision, the pupils usually being 
widely dilated. Rarely there are present epileptiform convulsions. 

Death may be postponed for some time, or it may rapidly follow 
a lethal dose. 

Treatment of Poisoning. — The patient should be placed in a 
horizontal position, better with the feet raised slightly. The 
stomach should be thoroughly evacuated ; bodily heat should be 
maintained by external warmth ; diffusible stimulants, such as ether, 
alcohol, and spirits of ammonia should be given hypodermically, 
the treatment being followed by administration of digitalis. Atro- 
pine and strychnine hypodermically are indicated to stimulate the 
respiration and assist in stimulating the heart. 

Therapeutics. — Externally and Locally. — Whether locally applied 
or given internally aconite is an excellent remedy in neuralgia, par- 
ticularly in tic douloureux. The tincture, aconite liniment, or an 
ointment of aconitine may be applied to the course of the affected 
nerve. The tincture of aconite frequently proves beneficial in 
herpes zoster, chilblain, pruritus, etc., and its extended application 
has even been recommended to ally the pain of chronic rheumatism. 

Internally. — Aconite is an exceedingly efficacious remedy in 
many febrile diseases, particularly the sthenic fevers of children and 
those fevers resulting from inflammation, such as tonsillitis, laryn- 
gitis, pharyngitis, quinsy, etc. The drug seems to exert a pecu- 
liarly beneficial influence on mucous membranes, all acute inflam- 
matory conditions of the throat, bronchial tubes, or intestinal canal 
— characterized by fever, a small, wiry pulse, and rapid cardiac 
action — being greatly improved by the remedy. 

As previously indicated, aconite is one of the most efficient 
sedatives in the irritative fevers of children. It is equally valuable 
in the first stage of pneumonia and in pleurisy ', and is an invaluable 
adjunct to opium in the treatment of peritonitis. 

Pericarditis is often favorably influenced by this drug, while it is 
also of great service in allaying nervous palpitation of the heart or 
that due to excessive cardiac hypertrophy. 

The injection into the rectum of 8 or 10 minims (0.5-0.6 Cc.) of 
the tincture of aconite, while perhaps producing a slight pro- 
lapsus of the rectum, quickly affects an irritable stricture of the 
urethra, so that a catheter may be passed with little difficulty, al- 
though the operation may have been previously found impossible. 



606 A TEXT-BOOK OF MA TERIA MEDICA. 

Probably there is no better combination to "break up a cold" 
than aconite and Dover's powder, the tincture of aconite, given at 
frequent intervals for a few hours, being followed, preferably at bed- 
time, with 8 or 10 grains (0.5-0.6 Gm.) of Dover's powder. 

Aconite has been favorably recommended in the acute stages of 
cerebrospinal meningitis and as a cardiac sedative in aneurysm. 

Contraindications. — Aconite is always contraindicated in sub- 
acute or chronic conditions or when the heart's action is weak. It 
is also intolerable in catarrhal conditions of the stomach. 

Administration. — A good, reliable tincture is the best prepara- 
tion for internal use. Moreover, better results are obtained by 
giving the drug in fraction of minim doses — from jV to i m i mm 
(0.006-0.03 Cc.) in a teaspoonful of water every fifteen minutes — 
than by larger dosage. The most desirable influence of the drug 
appears to be realized by this method. 

Veratrum Viride— Veratri Viridis— Veratrum Viride. 

TI. S. I>. 

(American Hellebore.) 

Origin. — The rhizome and roots of Veratrum viride Solander, a 
plant growing in swampy places and damp thickets in Canada, and 
in the United States as far south as Georgia. The plant closely 
resembles V. album of Europe, and is also allied to a species found 
in Eastern Siberia. 

Description and Properties. — Rhizome upright, obconical, 
simple or divided, from 2 to 3 inches (50 to 75 Mm.) long; exter- 
nally blackish-gray, internally grayish-white, showing numerous 
short, irregular wood-bundles. Many shrivelled, light yellowish- 
brown roots issue from all parts of the rhizome. 

The drug is inodorous, but strongly sternutatory when pow- 
dered, the taste being bitterish and very acrid. 

Veratrum viride contains the following alkaloids : jervine, pseu- 
dojervine, rubijervine, and cevadine. The first named is the cardiac 
depressant principle of the drug, and the remaining three are ster- 
nutatory. 

Veratrina (U. S. P.) is not found in this drug, as formerly sup- 
posed, Sabadilla being its principal source. Veratroidine, once 
supposed to be a distinct alkaloid, is probably only a mixture of 
rubijervine and a toxic resin. 

Dose. — J— 5 grains (0.01-0.3 Gm.). 



CARDIAC SEDATIVES. 607 

Official Preparations. 

ExtrSctum Veratri Vfridis Fluidum — ExtrScti Veratri Vlridis Fluidi — 
Fluid Extract of Veratrum Viride. — Dose, £-5 minims (0.01-0.3 Cc). 

Tinctura Veratri Viridis — Tinctiirae Veratri Vfridis — Tincture of Veratrum 
Viride (40 per cent.). — Dose, ^-5 minims (0.01-0.3 Cc). 

Allied Drugs. 

VerStrum Album — Veratri Albi — White or European Hellebore. 
Sebadftla— Sebadillae— Cevadilla. 

The seeds of this plant yield the following official alkaloid, known as Veratrine : 

Veratrina— Veratrlnae— Veratrine. U. S. I*. 

Description and Properties. — A white or grayish-white, amor- 
phous or semi-crystalline powder; odorless, but causing intense 
irritation and sneezing whenever even a minute quantity reaches 
the mucous membrane ; of an acrid taste, and leaving a sensation 
of tingling and numbness on the tongue ; permanent in the air ; 
very slightly soluble in hot or cold water, soluble in 3 parts of 
alcohol. 

Dose. — j^- \ grain (0.0016-0.016 Gm.). 

Official Preparations. 

Oleatum Veratrlnae — Oleati Veratrlnae — Oleate of Veratrine (2 percent.). 
For external use. 

UnguSntum Veratrlnae — UnguSnti Veratrlnae — Veratrine Ointment (4 per 

cent.). For external use. 



Antagonists and Incompatibles and Synergists are the same 
as for Aconite. 

Physiological Action. — The following remarks refer only to 
the crude drug, the actions of Jervine, the mixture Veratroidine, 
and Veratrine being given separately. 

Externally and Locally. — Veratrum is more of an irritant than 
aconite, exciting some inflammation of the skin when applied locally, 
and when in contact with the nasal mucous membrane producing 
violent sneezing. 

Internally. — Its effects are in every respect analogous to those 
of aconite, with the following exceptions, in the several systems : 

Digestive System. — Veratrum is more apt to occasion nausea 
and vomiting. 

Circidatory System. — The drug is a more powerful depressant 
to the circulation, small doses, while not materially affecting the 



608 A TEXT-BOOK OF MATERIA MEDICA. 

pulse-rate, greatly reducing its force, large doses rendering the 
pulse very weak, almost indistinguishable, and very rapid. 

Nervous System. — It does not, as does aconite, affect the sen- 
sory nerves, but in large doses paralyzes the motor system cen- 
trally, impairing the reflexes. Under moderate doses there is 
extreme muscular weakness. 

Respiratory System. — Veratrum depresses the respiration less 
than aconite. 

Absorption and Elimination. — The drug is absorbed with great 
facility, and is eliminated chiefly by the bowels. It possesses much 
feebler diuretic and diaphoretic properties than aconite. 

Temperature. — In medicinal doses it is not so powerful an anti- 
pyretic as aconite. 

Untoward Action. — Veratrum occasionally produces an erythem- 
atous or pustular eruption. 

Poisoning. — Except that the drug causes no cutaneous anesthe- 
sia or diminution of sensation, the symptoms of poisoning are 
almost identical with those occasioned by aconite. 

Treatment of Poisoning. — The same as prescribed for aconite. 

The Physiological Actions of jervine, veratroidine, and vera- 
trine are as follows : 

Externally and Locally. — Jervine is a mild irritant when applied 
to the skin or mucous membranes. Veratroidine is less irritating 
when similarly applied. Veratrine is a powerful irritant when 
applied by inunction, producing a tingling or prickling sensation, 
followed by pain and finally by numbness. 

Internally. — Digestive System. — Jervine has no noticeable effect 
upon the stomach and bowels, but produces marked salivation. 
Veratroidine in full doses occasions vomiting and purging. Vera- 
trine excites great irritation of the gastro-intestinal tract, causing 
profuse salivation, with vomiting and purging and severe epigas- 
tric pain. 

Circulatory System. — Jervine renders the pulse slower, softer, 
and fuller, with marked reduction of arterial pressure. This action 
is due to direct depression of the cardiac muscle or of the motor 
ganglia, the dilatation of the arterioles being the result of a de- 
pressant effect upon the vaso-motor center. 

Veratroidine retards the heart's action by stimulating the pneu- 
mogastrics. The arterial pressure is lowered by weakening of the 
heart. The vaso-motor center is not depressed, nor are the arte- 
rioles dilated. 



CARDIAC SEDATIVES. 609 

Veratrine markedly retards cardiac action, lengthening the 
diastolic period. The blood-pressure is decreased. 

Nervous System. — Jervine causes great muscular weakness, with 
abolition of reflexes, owing to its depressing action upon the motor 
areas of the spinal cord. Upon the cerebral motor areas, however, 
its influence is that of a stimulant, so that poisonous doses of this 
alkaloid produce convulsions of cerebral origin. The muscles 
themselves and the motor nerves are unaffected, though in the 
later stage of poisoning numbness is present, showing that some 
portion of the sensory mechanism is depressed. 

Veratroidine manifests the same action as jervine. 

Veratrine. — This alkaloid affects neither the brain nor the 
spinal cord. The motor and sensory nerves, on the other hand, 
betray its influence, being first stimulated and then paralyzed. 

The pain primarily produced by the local application of vera- 
trine is due to excessive stimulation of the peripheral endings of 
the sensory nerves. 

Respiratory System. — Jervine is a powerful depressant to the 
respiration, death occurring from asphyxia when lethal doses are 
taken. 

Veratroidine affects the system in like manner with jervine. 

Veratrine. — Small doses accelerate the respiratory movements. 
Large doses retard and finally arrest respiration — the former 
amounts acting as stimulants, and the latter causing paralysis of 
the respiratory center. 

Temperature. ^Moderate amounts of jervine and veratro- 
idine have no marked effect upon, while poisonous doses depress, 
temperature. 

Veratrine in large doses is more of an antipyretic than either 
jervine or veratroidine. 

Poisoning. — The symptoms of poisoning from either one of the 
above alkaloids would be a combination of the effects produced 
by lethal amounts, as stated, separately. 

Treatment of Poisoning. — The same as prescribed under Vera- 
trum Viride. 

Therapeutics. — Externally and Locally. — Veratrum viride is 
seldom, if ever, used locally. Veratrine, though in rare cases 
given internally, is wellnigh restricted to external or local appli- 
cation. 

The oleate or ointment of veratrine when applied over the 
affected nerve is exceedingly efficacious in ?ieuralgia, particularly 
39 



6lO A TEXT-BOOK OF MATERIA MEDICA. 

in tic douloureux and orbital neuralgia. In the latter affection great 
care should be taken in administration, lest some portion of the 
drug enter the eye, in which case violent and persistent conjuncti- 
vitis would ensue. 

Internally. — Veratrum viride may be employed for the same 
conditions for which aconite is recommended, although it is doubt- 
ful whether it possesses any advantages over the latter drug ; in- 
deed, by many competent physicians it is considered inferior to, 
and more dangerous than, aconite. Moreover, the nausea and 
vomiting which in many patients are likely to follow the ingestion 
of this drug render its use objectionable. A large number of 
physicians claim to have found it of value in the treatment of 
puerperal eclampsia. 

Contraindications. — The same as for aconite. 

Administration. — The tincture of veratrum viride only should 
be given, beginning with small doses, as recommended for aconite, 
and cautiously increasing the amount. Veratrine may be applied 
in the form of an ointment, oleate, or in solution together with 
alcohol and glycerin. 

Phytolacca Fructus— Phytolacca Fructus— Phyto- 
lacca Fruit. U. S. J*. 

Origin. — The fruit of Phytolacca decandra L., a perennial herb 
indigenous in North America, growing in waste places. 

Description and Properties. — A depressed-globular, dark- 
purple compound berry, about \ inch (8 Mm.) in diameter, com- 
posed often carpels, each containing one lenticular black seed; 
juice purplish-red, inodorous; taste sweet, slightly acrid. The 
fruit contains phytolaccin, phytolaccic acid, tannin, gum, sugar, and 
a coloring matter. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Phytolacca Radix— Phytolacca Radicis— Phyto- 
lacca Root. IT. S. J\ 

(Poke-root.) 

Origin. — The root of Phytolacca decandra L. 

Description and Properties. — Large, conical, branched, and 
fleshy ; mostly in transverse or longitudinal slices, wrinkled, gray- 
ish, hard; fracture fibrous, the wood-bundles in several distinct 
concentric circles ; inodorous ; taste sweetish and acrid. It con- 
tains resin, gum, fixed oil, tannin, starch, sugar, and a glucosid. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 



CARD I A C SEDA TI VES. 6 1 1 

Official Preparation. 

Extr^ctum Phytolacca R&dicis Fluidum — Extracti Phytolacca RSdicis 
Fluidi — Fluid Extract of Phytolacca Root. — Dose, 5-30 minims (0.3-2.0 Cc). 

Antagonists and Incompatibles. — The cardiac stimulants, 
opium, and ether oppose the action of phytolacca. 

Synergists. — All the members of this group ; the motor- 
depressants and emetics also enhance the action of the drug. 

Physiological Action. — Externally and Locally. — The pow- 
dered root is extremely irritating to mucous membranes, in certain 
subjects occasioning an erythematous eruption and excoriations. 

Internally. — Digestive System. — Phytolacca possesses emeto- 
cathartic properties. It occasions much nausea, with great de- 
pression, persisting for some time before vomiting occurs. The 
drug augments the secretion of bile and acts as a laxative. 

Circulatory System. — Like aconite, it reduces the force and fre- 
quency of the heart's action and lowers arterial tension. 

Nervous System. — Poke-root is a powerful motor depressant, 
acting as a direct paralyzant to the spinal cord and medulla, 
although the muscles and motor nerves are unaffected. 

Respiratory System. — Phytolacca is a respiratory depressant, 
rendering the breathing slow and shallow. Toxic doses produce 
death by paralysis of the respiratory center, preceded by tetanic 
convulsions. 

Absorption and Elimination. — The drug is readily absorbed, and 
is eliminated chiefly by the kidneys. 

Temperature. — Medicinal doses have no effect on temperature. 

Poisoning. — The symptoms of poisoning are quite similar to 
those produced by veratrum, though the nausea and vomiting are 
postponed longer after the ingestion of phytolacca. 

Treatment of Poisoning. — The same as recommended under 
Aconite and Veratrum. 

Therapeutics. — Externally and Locally. — Preparations of phyto- 
lacca have been successfully used to allay inflammation, as in cases of 
follicular pharyngitis, tonsillitis, mastitis, ulcers, buboes, burns, abscesses. 
The drug is also useful in chronic eczema, sycosis, favus, etc. The 
fluid extract may be applied, or the powdered root incorporated 
in ointment either singly or associated with other medicinal agents. 

Internally. — The drug has proved an efficient remedy in clironic 
rheumatism, its alterative properties rendering it also of some service 
in the treatment of scrofula, syphilis, and chronic diseases of the skin. 



612 A TEXT-BOOK OF MATERIA MEDICA. 

In mastitis, follicular pharyngitis, tonsillitis, etc. the internal use 
of the drug is indicated, mastitis especially often yielding readily 
to the internal use of the fluid extract, combined with the local 
application of an ointment containing phytolacca. 

It has been recommended in obesity, possessing undoubted 
efficacy in this respect. It is claimed that the proprietary prep- 
aration known as "Anti-fat" is a resinoid preparation of the berries. 

Contraindications. — The same as for veratrum viride. 

Administration. — No special directions are necessary. The 
powder, tincture, or fluid extract may be given internally ; for 
topical use an ointment may be prepared. 

Pulsatilla— Pulsatilla— Pulsatilla. U. S. I*. 

Origin. — The herb of Anemone Pulsatilla and Anemone pra- 
tensis L., collected soon after flowering. 

Description and Properties. — Leaves radical, petiolate, silky- 
villous, twice or thrice deeply three-parted or pinnately cleft, with 
linear, acute lobes, appearing after the large purple flowers ; in- 
odorous, very acrid. It contains a peculiar, acrid, crystallizable 
principle known as anemonin. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Unofficial Preparations. 

Extr2ctum Pulsatilla— Extr^cti Pulsatilla;— Extract of Pulsatilla.— Dose, 
i~3 grains (0.03-0.2 Gm.). 

Tinctiira Pulsatillas — Tinctiirae Pulsatilla? — Tincture of Pulsatilla. — Dose, 
10-20 minims (0.6-1.2 Cc). 

Anemonin. — Occurring in crystalline, colorless needles, soluble in warm alcohol, 
insoluble in water. — Dose, \-\ grain (0.05-0.01 Gm.). 

Antagonists and Incompatibles and Synergists the same as 
for Aconite. 

Physiological Action. — Externally and Locally. — Pulsatilla is 
a decided irritant to the skin, the bruised plant when rubbed upon 
it even producing vesication. In the mouth it produces a sensation 
of burning, succeeded by numbness. 

Internally. — The action of the drug is identical with that of 
aconite, though pulsatilla possesses greater emetic properties. 

Therapeutics. — The drug may be employed for the same pur- 
poses as aconite, though as a cardiac sedative it is less efficient. It 
has been recommended as a useful emmenagogue. 



CARD I A C SEDA TI VES. 6 1 3 

Arnicae Flores— Arnicae Florum— Arnica Flowers. 

U. S. JP. 

Origin. — The flower-heads of Arnica montana L., a plant in- 
digenous in the mountainous regions of Europe and Northern 
Asia, and also found in the northwestern part of America. 

Description and Properties. — Heads about 1 to 2 inches (25-50 
Mm.) in diameter, depressed-roundish, consisting of a scaly in- 
volucre in two rows, and a small, nearly flat, hairy receptacle, 
bearing about sixteen yellow, strap-shaped, ten-nerved ray-florets 
and numerous yellow, five-toothed, tubular disk-florets, with slen- 
der, spindle-shaped akenes crowned by a hairy pappus. Odor 
feeble and aromatic ; taste bitter and acrid. 

Arnica flowers contain a glucosid (?), arnicin, a volatile oil, 
capronic and caprylic acids, resins, tannin, etc. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparation. 

Tinctura Arnicae Florum — Tincturas Arnicae Florum — Tincture of Arnica 
Flowers (20 per cent.). — Dose, 10-30 minims (0.6-2.0 Cc). Chiefly, however, used 
externally as a vulnerary. 

Arnica Radix— Arnicae Radicis— Arnica Root. 

U. S. JP. 

Origin. — The rhizome and roots of Arnica montana L. 

Description and Properties. — The rhizome is horizontal, some- 
what contorted, 2 to 3 inches (5-7 Cm.) long, and \ or \ (3 or 4 
Mm.) or less in diameter, externally, brown, rough from leaf-scars, 
internally whitish, with a rather thick bark containing a circle of 
resin-cells surrounding the short, yellowish wood-wedges, and a 
large, spongy pith. The roots are numerous, thin, fragile, grayish- 
brown, with a thick bark containing a circle of resin-cells. Odor 
somewhat aromatic ; taste pungently aromatic and bitter ; the con- 
stituents the same as those of the flowers. 

Dose. — 5-30 grains (0.3-2 Gm.). 

Official Preparations. 

Extralctum Arnicae Radicis Fluidum — Extraxti Arnicae Raldicis Kluidi — 
Fluid Extract of Arnica Root. — Dose, 5-30 minims (0.3-2.0 Cc). 

Extralctum Arnicae Raldicis — Extralcti Arnicae Raldicis— Extract of Arnica 
Root. — Dose, 2-5 grains (0.13-0.3 Gm.). 

Emplalstrum Arnicae — Emplalstra Arnicae — Arnica Plaster (^2 P er cent, of 
extract). For external use. 



614 A TEXT-BOOK OF MATERIA MEDICA. 

Tinctura Arnicae R&dicis — Tincturae Arnicae R&dicis — Tincture of Arnica 
Root (10 per cent.). — Dose, 20-30 minims (1.3-2.0 Cc.). 

Antagonists and Ineompatibles and Synergists are the same 
as for Aconite. 

Physiological Action. — Externally and Locally. — The local 
action of both the root and flowers is irritant, that of the latter 
being the more powerful. Occasionally tincture of arnica flowers 
produces marked inflammation of the skin, resembling erysipelas. 

Internally. — The internal effects of arnica are as yet imperfectly 
understood, it being difficult to assign the drug to its proper group. 

Digestive System. — Small doses slightly stimulate the digestive 
apparatus. Large amounts produce nausea, vomiting, and diarrhea 
of a choleraic character. 

Circulatory System. — Small doses stimulate the heart and in- 
crease arterial pressure; full or large doses retard the pulse and 
depress the circulation. 

Nervous System. — Large amounts cause headache, with great 
depression of the nerve-centers. Toxic amounts occasion motor 
and sensory paralysis, coma, at times convulsions, collapse, and 
death. 

Respiratory System. — The respiration is slowed, although under 
small doses there may be temporary acceleration. 

Absorption and Elimination. — The active principle of arnica dif- 
fuses readily into the blood, the drug being eliminated chiefly by 
the kidneys, though the skin shares in the excretory process. 

Temperature. — Large doses cause a reduction of temperature. 

Untoward Action. — The topical application of arnica may cause 
in susceptible persons violent cutaneous inflammation and the pro- 
duction of pustules, or even distinct bullae, attended with marked 
constitutional symptoms. When taken internally the drug occa- 
sions a sensation of burning in the mouth and throat, violent pain 
in the stomach, tenesmus, and choleraic diarrhea, intense headache, 
and dizziness. 

Poisoning. — In addition to the above-named symptoms there are 
great cardiac depression, decided muscular weakness, slow and 
shallow respiration, paralysis of the nervous system, and death 
resulting from collapse. 

Treatment of Poisoning. — The treatment should be much the 
same as that prescribed under Aconite. Atropine is probably the 
best physiological antidote. 

Therapeutics. — Externally and Locally. — Arnica enjoys a well- 



CARD I A C SEDA TI VES. 6 1 5 

deserved reputation as an efficient remedy for the relief of bruises, 
sprains, and external inflammations generally. It has been recom- 
mended also as a topical application in myalgic rheumatism. The 
local application of the tincture causes the rapid disappearance of 
ecchymoses. Equal parts of the tincture of arnica and glycerin, 
diluted with water, have been recommended as a stimulant in 
inflammation of the mucous membrane of the moutli. 

Internally. — Arnica is not a very popular remedy for internal 
administration. It has, however, been used with varying success 
in idiopathic mania, delirium tremens, and rheumatic gout. It has 
also been beneficially employed in exhausting diarrhea, chronic dys- 
entery, epistaxis, hemoptysis, and paralysis of the bladder. 

Contraindications. — Externally when there exists any acute 
skin disease ; internally in cases of inflammation of the gastroin- 
testinal tract, fatty or valvular disease of the heart, and in all 
asthmatic conditions. 

Administration. — The tincture of arnica is the form generally 
preferred for external and internal use. In applying any prepara- 
tion externally the susceptibility to the irritating properties of the 
drug peculiar to certain persons should be remembered. 

Potassii NItras— Potassii Nitratis— Potassium 
Nitrate. TJ.S.P. 

(Nitre; Saltpetre.) 

Origin. — Purified from native Saltpetre. 

Description and Properties. — Colorless, six-sided, rhombic 
prisms, or a crystalline powder ; odorless, and having a cooling, 
saline, and pungent taste. Permanent in the air. Soluble in 3.8 
parts of water, very sparingly soluble in alcohol. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparations. 

ArgSnti NItras Dilutus — ArgSnti Nitratis Diliiti — Diluted Silver Nitrate. 
— Used externally. 

ChSrta Pot&ssii Nitratis — CMrtas (ace.) Potassii Nitratis — Potassium 
Nitrate Paper. — Intended for burning, the fumes to be inhaled. 

Antagonists and Incompatibles. — Cardiac and diffusible stim- 
ulants antagonize the action of potassium nitrate upon the heart. 
Mineral acids and metallic salts are incompatible. 

Synergists. — The cardiac depressants, diuretics, and agents 
increasing waste aid the action of potassium nitrate. 



616 A TEXT-BOOK OF MATERIA MEDICA. 

Physiological Action. — Externally and Locally. — The drug has 
no important local action. 

Internally. — Digestive System. — Large doses occasion nausea 
and vomiting; poisonous doses produce violent gastro-intestinal 
inflammation and diarrhea, blood sometimes being vomited and 
passed with the stools. 

Circulatory System. — Small doses have no marked influence on 
the circulatory system ; full doses act as a cardiac depressant, slow- 
ing and weakening the pulse ; poisonous doses produce great weak- 
ness, syncope, and death from cardiac failure. 

Nervous System. — No special action is noticeable, although poi- 
sonous doses produce tremulousness, insensibility, and convulsions. 

Respiratory System. — Large doses retard respiration. 

Absorption and Elimination. — Potassium nitrate passes rapidly 
into the blood unchanged, and is eliminated by the kidneys un- 
changed. Small doses are actively diuretic, stimulating the renal 
cells. Large amounts, from too free stimulation, are apt to irri- 
tate and inflame the kidneys, even so far as to produce hematuria. 
The drug is also eliminated to some extent by the skin, being 
therefore a mild diaphoretic. 

Temperature. — Unaffected by medicinal amounts, but lowered 
by poisonous doses. 

Poisoning. — There is violent gastro-intestinal inflammation, with 
vomiting and purging, blood being present in the ejecta and feces. 
Other symptoms are — subnormal temperature, coldness of the ex- 
tremities, a weak and thready pulse, slow and shallow respiration, 
tremulousness and great muscular weakness, dimness of vision or 
total blindness, deafness, insensibility, and possibly convulsions. 
The urine is diminished or suppressed. 

Should the patient recover from an immoderate dose of the 
drug, he suffers for some time from dysuria, irritability of the 
stomach, colic, muscular weakness, and a sensation of chilliness 
in the back and limbs. 

Treatment of Poisoning. — There is no special antidote for nitre ; 
cases of poisoning, therefore, are to be treated symptomatically, 
measures for relief including evacuation of the stomach, de- 
mulcents, opiates for pain, and cardiac and respiratory stim- 
ulants. 

Therapeutics. — Externally and Locally. — Solutions of this drug 
have been found serviceable as applications to bruises and abrasions. 
The last stage of pharyngitis is greatly relieved by a gargle of a 



CARDIAC SEDATIVES. 617 

solution of potassium nitrate, in the proportion of 1 drachm 
(4.0 Gm.) to 1 pint (473 Cc.) of water. 

It is claimed that a paste of powdered nitre and water applied 
to the face night and morning is an effective method of removing 
freckles. 

The difficulty of breathing in cases of spasmodic asthma may 
be greatly relieved by the inhalation of the fumes of burning 
nitre- PAPER. 

Internally. — The drug was formerly much used in acute artic- 
ular rheumatism and as a refrigerant and sedative in inflammations, 
pneumonia, and various fevers. It is employed to a considerable 
extent as a diuretic and diaphoretic, although greatly inferior to the 
acetates and citrates. 

Administration. — It should be given in solution, though the 
powder is sometimes used in combination with calomel, tartar 
emetic, or Dover's powder. 

The potassium-nitrate paper, as has been stated, should be 
burned and the fumes arising therefrom inhaled. 

Sodii NItras— Sodii Nitratis— Sodium Nitrate. 

TJ. S. JP. 

Origin. — It is found in great quantities imbedded in clay and 
sand in certain districts of Chili and Peru. 

Description and Properties. — Colorless, transparent, rhombo- 
hedral crystals,, odorless, having a cooling, saline, and slightly bit- 
ter taste; deliquescent in moist air. Soluble in 1.3 parts of water 
and in about 100 parts of alcohol. Sodium nitrate should be kept 
in well-stoppered bottles. 

Dose. — J-i ounce (1 5.5-31.0 Gm.). 

Physiological Action. — The action of the salt resembles closely 
that of potassium nitrate, though it is much feebler than the latter 
drug, while possessing greater purgative properties. 

Therapeutics. — Externally and Locally. — A solution of the salt 
possesses some power as a solvent of false membranes, and has 
been used in the form of a spray to diminish fibrinous exudations 
in the pharynx and larynx. 

Internally. — It may be employed for the same purposes as the 
potassium nitrate, and has been advantageously adopted as a laxa- 
tive in diarrhea and dysentery. 

Administration. — Sodium nitrate is best given dissolved in a 
large quantity of water. 



618 A TEXT-BOOK OF MATERIA MEDICA. 

GROUP X.— DIAPHORETICS. 

Diaphoretics — or sudorifics, as they are also called — are medi- 
cines which promote diaphoresis or sweating. Their action in 
stimulating transpiration by the skin may be enhanced by exer- 
cise, external warmth, nauseants, and drugs which dilate the vessels, 
determining more blood to the cutaneous blood-vessels. 

Diaphoretics are employed principally for their evacuant, revul- 
sive, and alterative effects, and to promote absorption. 

Pilocarpus— Pilocarpi— Pilocarpus. TJ. 8. P. 

(Jaborandi.) 

Origin. — The leaflets of Pilocarpus selloanus Engler (Rio Janeiro 
Jaborandi) and of Pilocarpus Jaborandi Holmes (Pernambuco Jabo- 
randi). 

Description and Properties. — About 4 to 6 inches (10—15 Cm.) 
long and J to 2\ inches (4-6 Cm.) broad, short-stalked, oval or 
ovate-oblong, entire and slightly revolute at the margin, obtuse 
and slightly emarginate, unequal at the base ; dull-green, coriace- 
ous, pellucid punctate, mostly smooth ; when bruised, slightly 
aromatic; taste somewhat bitter and pungent. 

Pilocarpus contains a volatile oil and two alkaloids, pilocarpine 
and jaborine, the latter being chemically isomeric with the former, 
although directly antagonistic in physiological action. 

Pilocarpidine, in many ways the equivalent of pilocarpine, has 
recently been isolated. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 

Official Preparation. 

Extractum Pilocarpi Fluidum — Extr&cti Pilocarpi Fluidi — Fluid Extract 
of Pilocarpus. — Dose, 5-60 minims (0.3-4.0 Cc). 



Pilocarpine Hydrochloras— Pilocarplnae Hydro- 
chloratis— Pilocarpine Hydrochlorate. U.S.I*. 

Origin. — The hydrochlorate of an alkaloid obtained from Pilo- 
carpus. 

Description and Properties. — Small, white crystals, odorless 
and of a faintly bitter taste ; deliquescent on exposure to damp air. 



DIAPHORETICS. 619 

Very soluble in water and in alcohol. It should be kept in small, 
well-stoppered bottles. 

Dose. — -gV~i g ram (0.001-0.03 Gm.). 

Jaborine is a yellow, amorphous alkaloid, isomeric with pilocarpine and closely 
resembling atropine in its physiological action. The varying effects which occasionally 
follow the use of the commercial pilocarpine are due to the presence of jaborine, which 
antagonizes the action of pilocarpine in almost every particular. 

It is highly important, therefore, when administering pilocarpine or any of its prep- 
arations to obtain the drugs free from jaborine, which is not used medicinally. 

Antagonists and Incompatibles. — Atropine is a perfect physi- 
ological antagonist to pilocarpine, being directly opposite in its 
action throughout its entire range, y^-g- grain (0.0006 Gm.) being 
sufficient to counteract \ grain (0.0 1 Gm.) of pilocarpine. Morphine 
relieves the nausea. 

The incompatibles are tannic acid, caustic alkalies, and the ferric 
and metallic salts. 

Synergists. — The cardiac depressants, particularly aconite and 
veratrum viride, gelsemium, sarsaparilla, spirit of nitrous ether, and 
drugs which paralyze the vaso-motor system, enhance the activity 
of pilocarpus. 

Physiological Action. — Externally and Locally. — There is no 
action of importance. 

Internally. — Digestive System. — The action of pilocarpine is here 
given, since the alkaloid fully represents the drug. 

When pilocarpine is taken into the mouth, the ends of the 
chorda tympani and secretory nerves are stimulated, causing an 
increased secretion of saliva. Should large doses be taken, there 
is a feeling of tenderness in the mouth and severe salivation is 
produced. 

The gastric glands are stimulated by the drug, their normal 
secretion being augmented. By stimulating the unstriped muscle- 
fibers pilocarpine increases peristalsis, both of the stomach and the 
intestines, in large doses acting as a cathartic. Immoderate amounts 
may also induce vomiting. The bile and pancreatic juice are not 
affected by moderate amounts of the drug. 

Circulatory System. — At first the vaso-motor nervous system is 
depressed, resulting in an acceleration of the cardiac movements, 
with dilatation of the blood-vessels. The heart, however, is soon 
slowed and the arterial pressure lowered, so that pilocarpine is in 
reality a cardiac depressant rather than a cardiac stimulant. 

Pilocarpine acts directly upon the heart, either by stimulating 



620 A TEXT-BOOK OF MA TERIA MEDICA. 

the terminations of the vagus or by depressing the motor centers 
in the heart-muscle or the muscle itself. 

Nervous System. — In medicinal amounts pilocarpine has no per- 
ceptible action on the central nervous system, although stimulating 
the nerve-terminations of involuntary muscles — i. e. those of the 
stomach, intestines, heart, spleen, bladder, uterus, etc. 

Poisonous doses have produced (in the frog) tetanic convulsions, 
followed by paralysis, the result of depression of the muscles and 
spinal centers, the nerves apparently being unaffected. 

Respiratory System. — The respiratory movements are unaffected 
by medicinal amounts, but the bronchial secretion is augmented. 

Absorption and Eliminatio?t. — Pilocarpine is rapidly absorbed, 
and is eliminated principally by the skin, occasioning free, and 
under large doses excessive, diaphoresis. 

The sweat is at first acid, then neutral, and finally alkaline in 
reaction. The diaphoresis produced by pilocarpine is due to stimu- 
lation of the secretory nerves supplying the glands. 

The kidneys, under small doses, are stimulated, there being a 
slight increase in the urine, while in disease the amount of urea is 
considerably augmented. 

The drug is also eliminated by the salivary glands, there being 
frequently an enormous increase in the salivary secretion. Under 
the influence of pilocarpine there is an increase in the gastric, 
bronchial, and lacrymal secretions, even the secretion of milk being 
notably augmented. 

Temperature. — Succeeding a very brief and slight elevation of 
temperature there is a decided diminution of bodily heat, resulting 
from the dilatation of cutaneous blood-vessels arid the evaporation 
of the perspiration. 

Eye. — Whether applied locally to the eye or taken internally, 
pilocarpine produces marked contraction of the pupil by stimulating 
the peripheral endings of the iridal nerves. The drug also pro- 
duces an increased tension of the eyeball. 

Uterus. — There is authority for the statement that pilocarpine 
stimulates the gravid uterus, inducing uterine contractions or in- 
creasing the energy of those already established. 

The effect of the drug upon the uterus, however, is more pro- 
nounced and apparent in cases of eclampsia, seeming to prove the 
fallacy of the statement that pilocarpine is a true ecbolic. 

Untoward Action. — Nausea and vomiting are of quite frequent 
occurrence, the vomiting being preceded by long and distressing 



DIAPHORE TICS. 62 1 

nausea. Occasionally the patient complains of severe pain in the 
urethra and in the lumbar region, with frequent desire to micturate. 

There have often been present headache, vertigo, hiccough, 
dimness of vision, gastric and abdominal pains, stupor, and chilli- 
ness. There may occur even collapse. 

Poisoning. — The symptoms produced by poisonous doses of 
pilocarpine are exaggerations of those described above, together 
with diarrhea, exhausting and excessive sweating and salivation, 
marked cardiac and respiratory depression, and collapse. 

Treatment of Poisoning. — If the drug has been ingested, the stom- 
ach should be immediately cleansed with a solution of tannic acid. 

To counteract the untoward effects of pilocarpine, whether the 
drug has been ingested or given by subcutaneous injection, atro- 
pine is undoubtedly the most complete physiological antagonist, 
and should be given hypodermically. Morphine is indicated to 
control the nausea and vomiting, while some of the cardiac stimu- 
lants may be required to counteract cardiac depression. 

Therapeutics. — Externally and Locally. — Pilocarpine, or the 
fluid extract of jaborandi, has been highly recommended for 
alopecia. By the use of pilocarpine the hair becomes darker. The 
fluid extract of pilocarpus has been employed as a local appli- 
cation in erysipelas and eczema. 

Lozenges containing -fa grain (0.00 1 Gm.) of pilocarpine are 
efficient in relieving dryness of the throat. As a myotic pilocarpine 
is used in many diseases of the eye. 

Internally. — The principal internal use of pilocarpine is as a 
diaphoretic in Bright' s disease. In cardiac dropsy it is not a safe 
remedy, because of its depressing influence upon the heart. 

The drug is very efficient in removing pleuritic effusion, while in 
uremic poisoning it is unquestionably the most valuable remedy we 
possess. 

The hypodermic injection of small doses of pilocarpine has 
been highly recommended as an efficient remedy in erysipelas, 
particularly during the first stages of the disease. 

The drug has been successfully used to abort malarial paroxysm, 
and has proved beneficial in tobacco and alcoholic amblyopia. 

Pilocarpine has been found useful in humid asthma, bronchor- 
rhea, and hiccough, and, in small doses, in arresting the sweating of 
phthisis and for the relief of ptyalism. The drug is an efficient 
galactogogue, and has been used with success in mumps, chronic en- 
largement of the cervical glands, and adenitis of the inguinal glands. 



622 A TEXT-BOOK OF MATERIA MEDICA. 

Pilocarpine materially lessens the flow of urine in diabetes in- 
sipidus, and in many diseases of the eye and ear the internal use of 
the drug serves a useful purpose. 

The property possessed by pilocarpine of stimulating the glands 
of the skin renders this remedy of great service in many chronic 
diseases of the skin characterized by a dry, scaly condition. It is a 
peculiarly valuable agent in phthiriasis, psoriasis, certain forms of 
eczema, pruritus senilis, etc. Pilocarpine or fluid extract of 
jaborandi may be useful in breaking up a cold. 

Finally, pilocarpine has been highly recommended in catarrhal 
jaundice, and is one of the most efficient antidotes to belladonna- 
poisoning. 

Contraindications. — The drug should never be employed when 
the heart is weak from thinning and atrophy of its walls or from fatty 
degeneration, nor where there is a tendency to pulmonary conges- 
tion and edema. The drug is also contraindicated in asthenic 
fevers, such as typhoid fever, etc. 

Administration. — Pilocarpine is superior to the crude drug, 
being far more reliable in its action and less liable to produce 
nausea and vomiting. Pilocarpine is usually given hypodermically, 
although it is frequently administered by the mouth, in solution, or 
in troches. 

Of all the preparations of the crude drug, the fluid extract and 
infusion are commonly employed, the latter being less apt to cause 
profuse salivation. An elixir of pilocarpus is prescribed consider- 
ably. 

Should preparations of jaborandi be given upon an empty 
stomach, they are less apt to occasion nausea. This inconvenience 
may be also avoided by giving an infusion by enema. 

Liquor Amrnonii Acetatis— Liquoris Ammdnii Ace- 
tatis— Solution of Ammonium Acetate. U. S. JP. 

(Spirit of Mindererus.) 

Origin. — An aqueous solution of Ammonium Acetate, contain- 
ing about 7 per cent, of the salt, together with small amounts of 
Acetic and Carbonic Acids. 

Description and Properties. — A clear, colorless liquid free 
from empyreuma, of a mildly saline, acidulous taste and an acid 
reaction. This preparation when required should be freshly made. 

Dose. — J-i fluidounce (15.0-30.0 Cc), in sweetened water. 



DIAPHORETICS. 623 

Official Preparation. 

Liquor Ferri et Ammonii Acetatis — Liquoris FSrri et Ammonii Acetatis — 
Solution of Iron and Ammonium Acetate (Basham's Mixture). — Described 
under " Preparations of Iron." 

Antagonists and Incompatibles. — The metallic sulphates, the 
salts of lead and silver, lime water, the carbonates of potassium 
and sodium, and acids are incompatible. 

Synergists. — Spirit of nitrous ether, potassium citrate, and 
many of the refrigerants and diaphoretics. 

Physiological Action and Therapeutics. — Solution of am- 
monium acetate is both a mild diaphoretic and diuretic, according 
as the action is governed by other more powerful agents. For 
instance, if the skin is warm and the cutaneous blood-vessels 
dilated, the preparation acts as a diaphoretic, while if the condition 
of the skin is the reverse, the action of the drug is directed to the 
kidneys. Should the preparation be given with aconite or spirit 
of nitrous ether, its action would be that of a diaphoretic, but if 
the drug were associated with digitalis or squill, it would act as a 
diuretic. In any case the action of the drug is due to a stimulation 
of the secretory cells or nerves. 

The principal medical use of solution of ammonium acetate is 
as a diaphoretic in febrile conditions, such as acute coryza, influenza, 
acute pharyngitis, etc. It is a very efficient remedy in muscular 
rheumatism, and in the eruptive fevers when the eruption is re- 
tarded. It is frequently associated with other remedies in the 
treatment of scarlatinous dropsy. 

Owing to its property of stimulating the heart and circulation, 
the remedy has been recommended in low forms of fever, in the 
belief that it helps to sustain the powers of life, in lowering the 
pulse and temperature, moistening the tongue, and quieting the 
delirium. 

In migraine and in alcoholic intoxication few remedies are so 
successful, the drug frequently dissipating the effects of acute 
alcoholism at once. 

The remedy has been found efficacious in dysmenorrhea and 
menorrhagia, and has been employed externally and locally as a 
discutient in mammary engorgements, gla?idular swelli?igs, contu- 
sions, incipient abscesses, etc. 

Administration. — The preparation, as has been said, should be 
freshly made when wanted, and should be administered well diluted 
with sweetened water. 



624 A TEXT-BOOK OF MATERIA MEDICA. 

Spiritus v^Etheris Nitrosi— Spiritus y^Etheris Nitrosi 
-Spirit of Nitrous Ether. U. S. JP. 

(Sweet Spirit of Nitre.) 

Origin. — An alcoholic solution of Ethyl Nitrite, yielding, when 
freshly prepared and tested in a nitrometer, not less than eleven 
times its own volume of nitrogen dioxide. 

Description and Properties. — A clear, mobile, volatile, and 
inflammable liquid, of a pale-yellowish or faintly greenish-yellow 
tint, having a fragrant, ethereal, and pungent odor free from acridity, 
and a sharp, burning taste. It should be kept in dark amber-col- 
ored, well-stoppered bottles, remote from lights and fire. 

Dose. — \-2 fluidrachms (2.0-8.0 Cc). 

Antagonists and Incompatibles. — The incompatibles are po- 
tassium iodide, ferric sulphate, antipyrine, mucilage of acacia, tinc- 
ture of guaiacum, and gallic and tannic acids. 

Synergists. — Diaphoretics, diuretics, antispasmodics, tincture 
of aconite, potassium citrate, etc. 

Physiological Action and Therapeutics. — When applied to 
the skin and allowed to evaporate spirit of nitrous ether produces 
a slight anesthetic effect. Internally, its action is very similar to 
that of the ammonium acetate. It dilates the blood-vessels more 
than the latter preparation, besides being more of a diffusible stim- 
ulant, stomachic, and carminative. 

Like the solution of ammonium acetate, spirit of nitrous ether 
acts either as a diaphoretic or diuretic, the effect depending upon 
the manner in which it is administered. For its diuretic action it 
should be given in ice-water and the patient kept cool ; to produce 
diaphoresis its administration should be accompanied by warm 
drinks and the patient be well covered. 

Spirit of nitrous ether is used for about the same purposes as 
the solution of ammonium acetate, being particularly serviceable in 
febrile affections to promote critical sweating, employed either alone 
or in combination with tincture of aconite. It is frequently given 
as a diuretic in Brighfs disease, congestion of the kidneys, and pain- 
ful affections of the urinary apparatus. 

It is a serviceable remedy to relieve flatulent distention of the 
stomach, to allay nausea, and to quiet nervous agitation. As an 
antispasmodic the remedy is frequently employed to relieve the 
pain of dysmenorrhea, and it may be inhaled for the relief of cough- 
ing. It enters into many expectorant mixtures, and is a soothing- 
application to the forehead in neuralgic headache. 



EMETICS. 625 

Administration. — The dose and manner of administering spirit 
of nitrous ether depend upon the action desired. As an anti- 
pyretic in febrile affections it should be given in doses of 20-30 
minims (1.30-2.0 Cc), in sweetened water, every half hour. To 
produce diuresis the drug should be associated with some other 
diuretic and given in larger doses, \-\ fluidrachm (2.0-4.0 Cc), 
every three or four hours. If the remedy is desired for its diapho- 
retic action, it should be given in hot water, in doses of 20 or 30 
minims (1.30-2.0 Cc), repeated every half hour, the patient being 
well covered. 

Should the drug be given as a nervous stimulant, the dose 
should not be less than 1 fluidrachm (4.0 Cc). 

Care should be exercised in the selection of spirit of nitrous 
ether that it be reliable and of full strength. If the preparation 
has been kept in large bottles exposed to light and air, the drug 
will be more or less inert and should not be prescribed. 



GROUP XL— EMETICS. 

1 Emetics are agents which produce vomiting or emesis. 

Vomiting is the result of the following actions : 1. The relaxa- 
tion of the cardia; 2. The contraction of the pylorus; 3. The con- 
traction of the gastric muscles ; 4. The contraction of the dia- 
phragm ; 5. The contraction of the abdominal muscles. The effect 
of these coordinate acts is to compress the stomach, expelling its 
contents through the relaxed cardia. 

The nervous mechanism involved in the act of vomiting is 
under the control of the medulla. The vomiting center may be 
stimulated in various ways — reflexly, through the sense of sight 
or taste, the stomach, peritoneum, biliary passages, kidneys, heart, 
or lungs, or by irritation of the pharynx or esophagus. The dia- 
gram (Fig. 14) serves to explain the mechanism of emesis. 

This is the nervous mechanism directly involved in the act of 
vomiting, regardless of the cause of the emesis. The vomiting 
center and a portion of the respiratory center intimately connected 
with it act simultaneously, either by way of the stomach or reflexly 
through other parts of the body — as is illustrated in certain injuries 
or diseases — or by direct stimulation of the center by some sub- 
stance carried to it in the blood. 

40 



626 A TEXT-BOOK OF MA TERIA MEDICA. 




Fig. 14. — A, A, abdominal walls ; B, respiratory muscle : 1, respiratory center ; 2, vomiting center ; 
3, stomach ; 4, afferent nerve passing from mucous membrane in stomach to vomiting center in me- 
dulla ; 5, efferent nerve passing from vomiting center to muscular fiber of cardia, relaxing it ; 6, efferent 
nerve passing from medulla to pylorus, contracting it ; 7, efferent nerve, influencing gastric muscles to 
contract; 8, efferent nerve, causing contraction of diaphragm; 9, efferent nerve, causing abdominal 
muscles to contract. 



The Local or Gastric Emetics 1 are — 

* Alum ; * Yellow Mercuric Sulphate ; 

* Copper Sulphate ; * Sodium Chloride ; 

* Zinc Sulphate ; * Ammonium Carbonate ; 

* Mustard. 

(The drugs marked with an asterisk (*) are considered elsewhere in the present 
\work.) 

The Direct or Systemic Emetics are — 
Apomorphine Hydrochlorate ; 
Antimony and Potassium Tartrate ; 
Ipecacuanha ; 
Lobelia. 

Local or gastric emetics are the more rapid in their action, 
producing emesis in from two to five minutes. The systemic 
emetics must be absorbed and pass to the medulla before they 
produce vomiting, consequently requiring more time to exert their 

1 Some authors reverse the nomenclature, considering those drugs which act only 
on the stomach " direct," and those affecting the medulla " indirect." 



EMETICS. 627 

influence. Moreover, the action of the latter class of emetics is 
of much longer duration and followed by greater depression of 
the muscular and circulatory systems, together with greater consti- 
tutional disturbance. 

Some emetics act both locally and centrally. Tartar emetic 
and ipecacuanha affect the stomach locally, but, since their action 
is chiefly upon the vomiting center through the circulation, they 
are classed as systemic emetics. Zinc sulphate and copper sul- 
phate, on the other hand, while to a slight extent acting on the 
medulla, are classed as local emetics, because their principal action 
is upon the mucous membrane of the stomach. 

Within a few minutes after an emetic has been ingested there is 
a feeling of nausea and distress, with decided muscular relaxation. 
The circulatory system is depressed ; the pulse is small and irregu- 
lar, and a sensation of faintness ensues. The flow of saliva is 
increased, and vomiting soon follows. During emesis the arterial 
tension is raised, the face is flushed, and there is an increase in 
bodily heat. When vomiting has subsided there is a reduction of 
temperature, with cardiac and muscular weakness, the skin being 
bathed in perspiration. Occasionally fatal syncope has followed 
the use of emetics. 



Antagonists. — Drugs known as Anti-emetics are used to allay 
nausea and check vomiting. Like emetics, these agents are divided 
into Local Anti-emetics or Gastric Sedatives and Direct or Sys- 
temic Anti-emetics, according to their action. 

Among the most important Anti-emetics are the following : 

Local Anti-emetics or Gastric Sedatives. 

(All save Ice are treated elsewhere in the present work.) 

Alcohol (especially champagne) ; Ether ; 

Arsenic (small doses) ; Ipecac (small doses) ; 

Belladonna; Ice; 

Bismuth subnitrate and subcar- Opium ; 

bonate ; Hydrocyanic acid ; 

Carbolic acid ; Menthol ; 

Cerium oxalate; Potassium nitrate ; 

Chloroform ; Silver nitrate ; 

Cocaine ; Sulphocarbolates ; 

Creasote ; Tincture of iodine (small doses). 
Calomel (small doses) ; 



628 A TEXT-BOOK OF MA TERIA MEDICA. 

Direct or Systemic Anti-emetics or Gastric Sedatives. 

Alcohol ; Chloral ; 

Ammonium; Hydrocyanic acid; 

Amyl nitrite ; Nitroglycerin ; 

Bromides ; Opium. 

It will be observed that some drugs are both local and direct 
Anti-emetics. 

There are certain measures which may be adopted to allay 
nausea and relieve vomiting, such as a recumbent posture and 
injection of large quantities of aerated water into the rectum. 

Synergists. — The emetics are of course mutually synergistic. 
Emetics are adjuncts to antiperiodics and expectorants, although 
the latter do not particularly enhance the action of the former. 

Emetics are used — 

1. To empty the stomach in cases where the presence of undi- 
gested food occasions pain, headache, etc., or to expel some poi- 
sonous substance from the stomach. For this purpose the local 
emetics are preferable. 

In cases of poisoning the local emetics are the more reliable. 

2. To remove foreign bodies from the esophagus. For this pur- 
pose the direct or systemic emetics should be used. 

3. To remove foreign bodies from the larynx, as in cases of 
membranous croup, laryngeal diphtheria, etc., the effort of vomit- 
ing being sometimes sufficient to dislodge and remove the mem- 
brane or other foreign substance. 

4. To remove the bronchial secretion in cases of bronchitis and 
catarrhal pneumonia. In these cases the direct emetics should be 
employed, preferably ipecacuanha or apomorphine, because they 
possess more expectorant properties. 

5. To empty the gall-bladder in cases of biliousness or malaria, 
or where small gall-stones are present in the gall-duct, the com- 
pression of the liver between the diaphragm and the abdominal 
muscles expelling the bile from the liver into the duodenum and 
forcing the gall-stones through the duct. 

6. To relax spasm of the pharyngeal muscles in cases of spas- 
modic laryngitis. For this purpose the systemic emetics are pref- 
erable. 

Contraindications. — Emetics should not be given to persons 
suffering from aneurysm, hernia, peritonitis, prolapse of the uterus 
or rectum, atheroma, or where there is very high arterial tension, a 



EMETICS. 629 

tendency to hemorrhage from the lungs or uterus, or a tendency 
to abortion. 

The emetic drugs which have not been elsewhere discussed in 
the present work are here given in detail : 

Apomorphlnae Hydrochloras— Apomorphinae Hy- 
drochloratis — Apomorphine Hydrochlorate. 
U. S. JP. 

Origin. — The hydrochlorate of an artificial alkaloid prepared 
from Morphine or Codeine. 

Description and Properties. — Minute, grayish-white, shining, 
acicular crystals, without odor, having a faintly bitter taste, and 
acquiring a greenish tint upon exposure to light and air. Soluble 
in about 45 parts of water and about 45 parts of alcohol. It 
should be kept in small, dark, amber-colored vials. If the prepa- 
ration imparts to 100 parts of water when slightly shaken an 
emerald-green color, the drug should be rejected. 

Dose. — aV ' A g ram (0.003-0.006 Gm.) by the mouth; ^g - \ 
grain (0.0025-0.01 Gm.) hypodermically. 

Physiological Action. — Externally and Locally. — None. 

Internally. — Digestive System. — From five to twenty minutes 
after ingestion — according to the dose and the manner of adminis- 
tration — vomiting ensues, being repeated three or four times at 
intervals of about fifteen minutes. The emesis is preceded and 
attended by a slight nausea, with but moderate depression. Apo- 
morphine is a typical direct or systemic emetic, its entire action 
being exerted upon the vomiting center in the medulla. It is per- 
haps the most powerful and certain emetic we possess. 

Circulatory System. — Small doses have no perceptible effect upon 
the circulation. Full doses increase the rapidity and force of the 
heart's action and raise arterial pressure, owing to stimulation of the 
accelerator nerves and vaso-motor center. Large or toxic amounts 
depress the circulatory system or paralyze the cardiac muscle. 

Nervous System. — Full doses stimulate the brain and may even 
occasion delirium. Poisonous amounts produce convulsions, prob- 
ably of spinal origin, succeeded by paralysis of the motor and sen- 
sory nerves, and consequently of the muscles. 

Respiratory System. — Small amounts do not affect the respira- 
tory movements, although the secretion from the bronchial mucous 
membrane is increased. Full doses accelerate and deepen respira- 
tion, while toxic amounts cause depression. 



630 A TEXT-BOOK OF MATERIA MEDICA. 

Absorption and Elimination. — Apomorphine is readily absorbed, 
and is excreted through the gastro-intestinal tract, as well as by the 
broncho-pulmonary mucous membrane, the kidneys, and the skin. 

Temperature is unaffected by small doses, but may be lowered 
by large amounts. 

Poisoning. — The symptoms would be violent vomiting, delirium 
or convulsions, and marked cardiac and respiratory depression, 
death resulting from asphyxia. 

Treatment of Poisoning. — The systemic gastric sedatives and 
cardiac stimulants. 

Therapeutics. — Apomorphine is the most reliable emetic to use 
when prompt emesis is necessary or in cases where swallowing is 
difficult or impossible. 

It is extremely useful as an emetic in cases of poisoning, though 
it frequently happens in narcotic poisoning that the vagus center is 
so blunted by the poison that apomorphine fails to act. 

Should it be necessary to provoke emesis when the stomach is 
in a state of acute inflammation, apomorphine is preferable to any 
other emetic. 

Given by the mouth in small doses — from -fa grain (0.00 1 Gm.) 
to rfa- grain (0.003 Gm.) every three or four hours — this drug is an 
exceedingly efficient remedy in acute bronchitis. It is equally 
beneficial in relieving the dry, hacking cough of chronic bronchitis, 
chronic catarrhal pneumonia, and tuberculosis. 

Contraindications. — The same as for emetics generally. 

Administration. — Apomorphine when given as an emetic 
should invariably be administered hypodermically, and the solu- 
tion be always freshly prepared. When the drug is used as an 
expectorant it should be given by the mouth. Great care should 
be taken in administering the drug to children, as they bear the 
remedy very badly. 

Antimonii et Potassii Tartras— Antimonii et Potas- 
sii Tartratis— Antimony and Potassium Tartrate. 

U. S. JP. 

(Tartar Emetic; Tartrated Antimony.) 
Origin. — Antimony Trioxide is mixed with Acid Potassium 
Tartrate and Water to the consistence of a paste, allowed to stand 
for twenty-four hours, boiled in water, and crystallized. 

Description and Properties. — Colorless, transparent crystals 
of the rhombic system, becoming opaque and white on exposure 



EMETICS. 631 

to air, or a white, granular powder, without odor and having a 
sweet, afterward disagreeable, metallic taste. Soluble in 17 parts 
of water and in 3 parts of boiling water, but insoluble in alcohol, 
which precipitates it from its aqueous solution in the form of a 
crystalline powder. 

Dose. — As an emetic, 1-2 grains (0.06-0.12 Gm.) ; as a cardiac 
depressant, J-i grain (0.03-0.06 Gm.) ; as a diaphoretic and 
expectorant, -^-\ grain (0.003-0.01 Gm.). 

Official Preparations. 

Syrupus Scfllae Compositus — Syrupi Scillse Compositi — Compound Syrup 
of Squills (Hive Syrup). — Formula: Fluid Extract of Squill, 80; Fluid Extract of 
Senega, 80; Antimony and Potassium Tartrate, 2; Sugar, 750; Precipitated Calcium 
Phosphate, io; Water, to 1000. 

Dose. — 5-60 minims (0.3-4.0 Cc). 

VInum Antimonii — VIni Antimonii — Wine of Antimony. — Formula: Anti- 
mony and Potassium Tartrate, 4; Boiling Distilled Water, 65; Alcohol, 150; White 
Wine, to 1000. 

Dose. — 5-60 minims (0.3-4.0 Cc). 

Antagonists and Incompatibles. — Opium, alcohol, and the 
cardiac stimulants and antispasmodics generally are antagonistic. 
Tannic and gallic acids and the lead salts are incompatible. 

Synergists. — Emetics, cathartics, and cardiac depressants pro- 
mote the action of tartar emetic. 

Physiological Action. — Externally and Locally. — Tartar emetic 
is a powerful irritant when applied to the skin, producing a fol- 
licular inflammation followed by a papular eruption, becoming 
vesicular, and later forming pustules with a central umbilication, 
desiccation finally occurring, the pustules closely resembling those 
of small-pox. 

Internally. — Digestive System. — Upon the mucous membrane of 
the gastro-intestinal tract, as upon the skin, antimony and potas- 
sium tartrate acts as a powerful irritant. Small doses, occasioning 
only a sensation of warmth in the stomach, soon produce an in- 
creased secretion of saliva and gastric juice, as well as of secretions 
from the intestines, liver, and pancreas, more or less nausea fre- 
quently accompanying these symptoms. 

A little larger dosage excites vomiting, due at first to the irri- 
tating action of the drug' upon the mucous membrane and nerves 
of the stomach, and, as soon as the drug is absorbed, affecting 
directly the vomiting center in the medulla. Full or large doses 
irritate the intestines, producing diarrhea, the discharges, if the dose 



632 A TEXT-BOOK OF MATERIA MEDICA. 

has been excessive, strikingly resembling those of cholera. Ac- 
companying the foregoing symptoms are severe cramps and 
epigastric pain. 

Circulatory System. — Tartar emetic is a powerful cardiac de- 
pressant, even in small doses slowing and weakening the heart's 
action, and simultaneously lowering arterial pressure by direct de- 
pression of the heart-muscle. 

Poisonous doses of the drug profoundly depress the heart, 
which is finally arrested in diastole. 

Nervous System. — Antimony and potassium tartrate in small 
doses and under certain conditions exerts a sedative influence upon 
the brain. Indeed, its action is that of a depressant to the entire 
nervous system, particularly the spinal cord, small doses depressing 
the sensory side, while poisonous doses paralyze both the motor 
and sensory centers of the cord. 

Under the administration of antimony, therefore, reflex excita- 
bility is diminished and the muscular system is depressed, the drug 
acting as an antispasmodic, probably by its influence both upon the 
muscles and the nervous system. 

Respiratory System. — Very small doses have no effect upon 
the respiratory movements, but increase the secretions from the 
bronchial mucous membrane. Full doses depress the respiratory 
movements, shortening the inspiration, but prolonging expiration. 
Toxic doses render the breathing extremely irregular and greatly 
lengthen the pause between inspiration and expiration, while there 
is an enormous increase in the bronchial secretion. 

The action of tartar emetic upon the respiratory system is very 
complex. The explanation as given by Hare is : " Primarily the 
respiratory center in the medulla is depressed, and the governing 
nerves of breathing, the pneumogastrics, are also rendered inactive ; 
secondarily, the cardiac failure readily causes pulmonary conges- 
tion ; and, thirdly, the drug causes such an outpouring of liquid 
and mucus into the bronchial tubes that the patient is drowned in 
his own secretion, which he is too weak to expel." 

Absorption and Elimination. — Tartar emetic rapidly enters the 
blood, and is eliminated by many channels, principally by the 
bowels, but also by the bile, milk, sweat, and urine. The drug is 
an active diaphoretic, expectorant, and cholagogue. 

Temperature. — Small doses do not affect temperature percep- 
tibly ; large doses lower bodily heat, chiefly by depressing the 



EMETICS. 633 

circulation, although the drug may possibly influence the heat- 
center to some extent, lessening heat-production. 

Ufitoward Action. — The untoward manifestations produced by 
medicinal amounts of tartar emetic in individuals having a marked 
susceptibility to the drug do not differ essentially from the symp- 
toms of poisoning next described. 

Poisoning. — Tartar emetic produces all the symptoms of an 
irritant poison — severe burning sensation in the esophagus and 
stomach and violent and repeated vomiting, the ejecta, in addition 
to undigested food, containing mucus, bile, and frequently blood. 

These symptoms are attended with severe colicky pains in the 
abdomen and serous purging, the discharges resembling those of 
cholera, the analogy with the latter disease being rendered the 
more striking by the presence of cramps in the extremities — a cha- 
racteristic feature of poisoning by tartar emetic. 

Together with these gastro-intestinal symptoms there is extreme 
prostration, accompanied by an irregular, weak, almost impercep- 
tible pulse, great muscular relaxation, depressed respiration, pinched 
and livid countenance, cold, clammy skin, reduction of tempera- 
ture, and scanty and bloody urine. Death may be preceded by 
stupor, wild delirium, or convulsions. 

Treatment of Poisoning. — If the poison has not been entirely 
ejected in the act of vomiting, the stomach should be immediately 
washed out with a solution of tannic acid, after which strong coffee 
should be administered, together with demulcent drinks, anodynes, 
and respiratory and cardiac stimulants should they be necessary. 

Therapeutics. — Externally and Locally. — Tartar emetic was 
formerly used as a rubefacient, being still so employed to some 
extent. The tendency of the drug, however, to produce extensive 
papular eruption and destruction of tissue renders its external use 
unsafe. Hebra considers that the external use of tartar emetic is 
a " useless, injurious procedure, and occasionally even dangerous 
to life." 

S. Hartwell Chapman has recommended the use of a lozenge 
containing ^-J-q- grain (0.0003 Gm.) of tartar emetic and J 7 grain 
(0.00 1 Gm.) of codeine in acute inflammation of the throat when 
accompanied with fever. 

Internally. — The medical uses of tartar emetic are constantly 
becoming more restricted. Because of its slow and depressing 
action the employment of the drug as an emetic has been prac- 
tically abandoned. It is still used as a sedative antiphlogistic in 



634 A TEXT-BOOK OF MATERIA MEDICA. 

various acute i?iflammations. It is beneficial in the early stages of 
acute laryngitis and bronchitis, but its administration should be dis- 
continued after a free secretion of bronchial mucus is established. 

The remedy is given by many practitioners in the early stages 
of acute lobar pneumonia. 

The compound syrup of squills is a useful expectorant, being 
a popular and efficient remedy for croup. 

Administration. — As an emetic the action of the drug is facili- 
tated and enhanced by associating it with ipecacuanha, the reme- 
dies together being given in powdered form. 

As a diaphoretic and expectorant small doses of the wine of 
antimony are preferable, repeated every two or three hours. 

Ipecacuanha— Ipecacuanhae— Ipecac. ~U. S. JP. 

Origin. — The root of Cephaelis Ipecacuanha (Brotero) A. Rich- 
ard, a plant indigenous in the damp forests of Brazil, New Granada, 
and the northeastern portion of Bolivia. It is cultivated to some 
extent in India and Sikkim. 

According to the National Dispensatory, " The drug first be- 
came known in Europe in 1672, and a few years after was success- 
fully employed by Helvetius, a Dutch physician living in Paris, 
from whom (1688) Louis XIV. purchased the secret for 1000 louis 
d'or and made it public." 

Description and Properties. — The older roots are in pieces of 
2 to 6 inches (5-15 Cm.) in length and about \ inch (4 Mm.) thick, 
mostly simple, contorted, dull grayish-brown or blackish, finely 
wrinkled, closely and irregularly annulated and often transversely 
fissured; bark thick, brittle, brownish, easily separated from the 
thin, whitish, tough, ligneous portion ; odor slight, peculiar, nau- 
seous ; taste bitterish, acrid, nauseating. When ipecac is sound 
and free from mouldiness its quality is proportionate to the thick- 
ness of the bark and the thinness of the ligneous portion. 

The active principles of ipecac are emetine and cephaeline, of the 
former of which there is present 1 to 2 per cent. The drug also 
contains ipecacuanhic or cephaelic acid, starch, resin, etc. 

Dose. — As an emetic, 15-30 grains (1.0-2.0 Gm.); as an expec- 
torant, |— 2 grains (0.03-0.12 Gm.). 

Official Preparations. 
Extratctum Ipecacuanhae Fluidum — Extratcti Ipecacuanhae Fluidi — Fluid 
Extract of Ipecacuanha. — Dose, as an emetic, 15-30 minims (0.2-0.5 Cc.) ; as an 
expectorant, \-2 minims (0.03-0. 1 2 Cc). 



EMETICS. 635 

Ptilvis Ipecacuanhas et Opii — Ptllveris Ipecacuanhas et Opii — Powder of 
Ipecac and Opium. (See Opium, p. 453.) 

Syrupus Ipecacuanhas — S^rupi Ipecacuanhas — Syrup of Ipecac. — Formula: 
Fluid Extract of Ipecac, 75; Acetic Acid, 10; Glycerin, 100; Sugar, 700 ; Water, to 
1000. — Dose, as an emetic, 2-6 fluidrachms (7.39-22.50 Cc.) ; as an expectorant, 5-30 
minims (0.3-2.0 Cc). 

Tinctiira Ipecacuanhas et Opii — Tincturae Ipecacuanhas et Opii — Tincture 
of Ipecac and Opium. (See Opium, p. 453.) 

Trochisci Ipecacuanhas — Trochiscos (ace.) Ipecacuanhas — Troches of Ipe- 
cac. — Composition: Each troche contains about \ grain (0.02 Gm.) of Ipecac, together 
with Tragacanth, Sugar, and Oil of Orange. 

Dose. — 1 to 6 troches. 

Trochlsci Morphinas et Ipecacuanhas — Trochiscos (ace.) Morphinas et Ipe- 
cacuanhas. (See Morphine, p. 454.) 

VInum Ipecacuanhas — Vlni Ipecacuanhas — Wine of Ipecac (10 per cent.). — 
Dose, 1-60 minims (0.06-4.0 Cc). 

Antagonists and Incompatibles. — The gastric sedatives and 
narcotics generally hinder the emetic properties of ipecac. The in- 
compatibles are tannic acid and vegetable infusions containing it, 
metallic salts, and caustic alkalies. 

Synergists. — The emetics, sedative expectorants, warm drinks, 
are synergistic, and opium aids the diaphoretic properties of the 
drug. 

Physiological Action. — Externally and Locally. — Ipecac is a 
powerful irritant to the mucous membranes of the respiratory tract 
when the powdered drug is inhaled. The prolonged application 
of ipecac to the skin occasions much irritation, even producing 
vesication, pustulation, and ulceration. Ipecac also possesses some 
antiseptic properties. 

Internally. — Digestive System. — In small doses ipecac acts as a 
stimulant to the stomach. The salivary and gastric glands are 
stimulated, the action of very small doses of the drug resembling 
that of vegetable bitters. 

Large doses are powerfully irritant and emetic, the emesis being 
the result of both a local irritation upon the stomach and per- 
haps some slight action on the vomiting center. The vomiting is 
preceded by and attended with but little if any nausea, although 
there is usually a marked increase in the secretion of bile and intes- 
tinal mucus, full doses of the drug acting not only as an emetic, 
but as a purgative and cholagogue. 

Circulatory System. — Except in occasioning the ordinary depres- 
sion incident to the act of vomiting, ipecac in moderate amounts 
has no influence upon the heart. Enormous doses, however, par- 



636 A TEXT-BOOK OF MATERIA MEDICA. 

ticularly if injected into the jugular vein, have destroyed the life 
of dogs by cardiac paralysis. 

Nervous System. — Save in stimulating that portion of the me- 
dulla oblongata which presides over the act of vomiting, and a 
slight diminution of the reflex activity of the spinal cord, ipecac 
has no important action upon the nervous system. 

Respiratory System. — So far as the respiratory movements are 
concerned, they are unaffected by moderate doses of ipecac. The 
bronchial mucous membrane is stimulated, augmenting the se- 
cretion of bronchial mucus, and therefore reflexly stimulating 
coughing. 

Absorption and Elimination. — The active principle of ipecac is 
rapidly absorbed, being eliminated chiefly by the gastro-intestinal 
mucous membrane, although the other secretions share in the 
excretory process, the skin being especially affected by this drug, 
which acts as a mild diaphoretic. 

Temperature. — Under medicinal doses the temperature is un- 
changed. Poisonous doses reduce temperature. 

Untoward Action. — Rarely, in persons peculiarly susceptible to 
the drug, intense cutaneous irritation and conjunctival inflammation, 
accompanied by neuralgia of the face and scalp, have been produced. 
Even soiling the hand with a few drops of the tincture of ipecac has 
occasioned unfavorable results. The general untoward symptoms 
are those of poisoning. 

Poisoning. — There is violent vomiting and purging, the ejecta 
containing bile and frequently blood. Among the graver symp- 
toms are abdominal pain, marked cardiac depression, muscular 
weakness, and greatly diminished reflex irritability. The skin is 
cold and bathed in perspiration. 

Treatment of Poisoning. — Tannic acid should be given as the 
chemical antidote. Opium, belladonna, and cardiac stimulants may 
be necessary. 

Therapeutics. — Externally and Locally. — Troches of ipecac 
and spray inhalations of wine of ipecac are used to allay the cough 
and expectoration in acute bronchitis and obstinate " winter cough!' 

Powdered ipecac has been successfully employed as a dressing 
in anthrax, the drug being capable of destroying the anthrax 
bacilli, although having no effect on the spores. 

Internally. — Ipecac in proper doses is a very efficient emetic, 
and is frequently employed as such, particularly when it is desir- 
able through the act of vomiting to empty the air-passages, as in 



EMETICS. 637 

croup, bronchitis, tracheitis, and the early stages of diphtheria. The 
action of the drug is so tardy, however, that it is not the most de- 
sirable emetic to use when it is necessary to empty the stomach 
quickly, as in cases of poisoning. 

When the stomach contains a quantity of undigested food, 
causing pain, headache, etc., ipecac is a valuable emetic to empty 
the stomach, since the drug occasions no marked nausea or de- 
pression. 

Paradoxical as it may seem, minute doses of ipecac, such as 1 
to 4 minims (0.06-0.2 Cc.) of the wine or -^ to \ grain (0.006-0.01 
Gm.) of the powdered drug, act as an efficient gastric sedative 
and stomachic, frequently arresting vomiting when other drugs have 
failed. The statement, however, that minim doses of the wine of 
ipecac allay the nausea and vomiting of pregnancy is probably 
apocryphal. 

Ipecac in small doses is an excellent adjuvant to other chola- 
gogues to relieve the distress of hepatic dyspepsia. The drug is 
equally advantageous in atonic dyspepsia, attended with flatulence, 
depression of spirits, etc. 

The notoriety and pecuniary profit which Helvetius secured in 
connection with ipecac — or Radix antidysentcrica, as it was origi- 
nally named by its propagator — were due to its apparent specific 
action in dysentery. 

The drug is peculiarly efficient in dysentery of a bilious type, 
acute dysentery other than bilious yielding less readily to the rem- 
edy. It is true that in these last-named cases ipecac and opium 
have been advantageously employed, though it is probable that the 
opium had the larger influence in modifying the course of the dis- 
ease. Whatever the form of dysenteric attack may be, ipecac is 
the more efficient the earlier it is administered. 

The drug, in order to exert any beneficial influence in bilious 
dysentery, must be given in large doses — 60 to 90 grains (3.88- 
5.83 Gm.)in a single dose or 20 grains (1.29 Gm.) every four hours. 
These doses of course will at first produce emesis, but the repeti- 
tion of them tends to establish a tolerance of the remedy, an early 
attainment of which is most desirable. 

Various methods have been employed to aid the stomach in 
retaining the drug, such as the administration of opium or other 
gastric sedative, a sinapism placed upon the epigastrium, etc. 

Ipecac has been highly recommended in infantile diarrhea. It 
has been successfully employed in hemat erne sis and uterine honor- 



638 A TEXT-BOOK OF MATERIA MEDICA. 

rhage, it being customary in the former complaint to give at first 
an emetic dose, succeeded by smaller and nauseating amounts. 

Like other emetics, ipecac has proved efficient in expediting 
labor by relieving rigidity of the os uteri. 

The drug has been found beneficial in relieving hemoptysis, and 
it is of unquestioned value in many affections of the lungs and 
bronchial tubes. In pneumonia, particularly in the congestive and 
declining stages of the disease, it has proved serviceable. 

In bronchitis and phthisis, especially when the secretion is scanty, 
and in chronic bronchitis with much cough and but a moderate 
amount of expectoration, ipecac is a valuable remedy. It has been 
found valuable in spasmodic asthma. 

Ipecac is an important adjuvant to quinine in the treatment of 
remittent and intermittent fevers, the latter disease having been 
cured, it is claimed, by ipecac alone in doses of I or 2 grains 
(0.06-0.12 Gm.), given every three or four hours. 

Contraindications. — Ipecac is not permissible for patients suf- 
fering from aneurysm, hernia, prolapse of uterus or rectum, etc. 

Administration. — The drug is notoriously uncertain in its 
action, probably because of the variation in the percentage of eme- 
tine, the freshly powdered root being ordinarily more reliable. 

For purposes of emesis the freshly powdered root is preferable, 
to be taken with plenty of warm water. An infusion or decoction 
is frequently employed to produce emesis. 

As a diaphoretic the powder is also preferable, though in any 
case the fluid extract may be substituted for the powdered form. 
As an expectorant the syrup and wine are the preparations usually 
employed. 

Children are very tolerant of ipecac, the syrup being the prepa- 
ration usually given to them. 

Emetine, though not official, is an important remedy, and may 
be administered as an emetic in doses of -^ to \ grain (0.005-0.01 
Gm.), and in correspondingly small doses when a diaphoretic or 
expectorant action is desired. 

Lobelia— Lobeliae— Lobelia. U. S. JP. 

(Indian Tobacco.) 

Origin. — The leaves and tops of Lobelia inflata L., collected 
after a portion of the capsules have become inflated. The plant 
is indigenous in the United States. 

Description and Properties. — As it appears in the market 



EMETICS. 639 

lobelia consists of fragments of green leaves, stems, rather elon- 
gated dried flowers, and portions of the membranous capsules. 
The odor is very irritating, and the taste pungent and persistently 
acrid. The plant contains a yellowish acrid liquid alkaloid, lobeline, 
besides lobelic acid, lobelacrin, resin, fixed oil, gum, etc. 
Dose. — 1-10 grains (0.065-0.6 Gm.). 

Official Preparations. 

Extraxtum Lobeliae Fluidum — Extratcti Lobeliae Fluidi— Fluid Extract of 
Lobelia. — Dose, i-io minims (0.06-0.6 Cc). 

Tinctura Lobeliae — Tincturae Lobelias — Tincture of Lobelia (20 per cent.). 
— Dose, 8-15 minims (0.5-1.0 Cc). 

Antagonists and Incompatibles. — The effects of lobelia on the 
circulatory system are antagonized by the cardiac stimulants ; its 
influence on the nervous system is counteracted by strychnine and 
other motor excitants. The incompatibles are all caustic alkalies. 

Synergists. — The motor depressants and emetics enhance the 
effects of lobelia. 

Physiological Action. — Externally and Locally. — Although the 
drug is readily absorbed through the skin, there is no action of 
importance. 

Internally. — Digestive System. — Lobelia produces symptoms 
similar to those of ipecac, save that lobelia is more powerful, occa- 
sioning more distressing nausea and intense prostration. 

Circidatory System. — Lobelia is a powerful cardiac depressant, 
its action being due both to direct depression of the heart and 
paralysis of the vaso-motor centers. Under poisonous doses the 
heart stops in diastole. 

Nervous System. — Full doses depress the motor nerve-ganglia. 
Poisonous doses are necessary to affect the higher cerebral centers, 
when coma and convulsions are produced. The muscles and 
nerves themselves are unaffected by lobelia. 

Respiratory System. — The muscular coats of the bronchi are 
relaxed by the drug. The respiration is slowed even by small 
doses. Large or toxic doses profoundly depress the respiratory 
center, death resulting from respiratory failure. 

Absorption and Elimination. — The active principle of lobelia is 
readily absorbed, and is excreted chiefly by the kidneys and 
skin, the drug acting as a diuretic and diaphoretic. Under emetic 
doses much of the drug is eliminated by way of the stomach and 
intestines. 



640 A TEXT-BOOK OF MATERIA MEDIC A. 

Temperature. — Full doses lower the temperature. 

Untoward Action. — Does not differ essentially from the effects 
of poisoning. 

Poisoning. — The symptoms include — violent vomiting and 
purging, a very weak and irregular pulse, an anxious, livid coun- 
tenance, skin cold and bathed in perspiration, respiration slow and 
very feeble, contracted pupils, and possibly coma or convulsions 
preceding death, which occurs from respiratory failure. 

Treatment of Poisoning. — The symptoms should be counter- 
acted by cardiac and respiratory stimulants, employing such drugs 
as atropine, strychnine, alcohol, ammonia, etc., hypodermically. 

Therapeutics. — Externally and Locally. — None. 

Internally. — While formerly lobelia was used extensively as an 
emetic, at the present day, owing to the intense nausea and great 
depression occasioned by the drug, it has been practically sup- 
planted by other less dangerous emetics. 

Its principal use nowadays is as a remedy in spasmodic asthma 
and as an expectorant in certain cases of bronchitis. 

Contraindications. — The same as for emetics in general. 

Administration. — The powder, fluid extract, or tincture may 
be used. The taste of the fluid preparations may be agreeably 
disguised by aromatic elixir or aromatic elixir of liquorice. 



GROUP XII.— EXPECTORANTS. 

Expectorants are drugs which stimulate, depress, or modify 
the secretion from the bronchial or laryngeal membrane and pro- 
mote its expulsion. 

There are many drugs not classed as expectorants which, under 
certain conditions, may be used to serve one of these purposes. 
Thus, opium and chloral, by the depressing influence which they 
exert upon the respiratory center and the reflex mechanism; may 
relieve reflex and purposeless cough, or, as is the case with the 
former drug, check excessive secretion or render it more viscid. 

Demulcents, such as gum acacia, flaxseed, elm, etc., and other 
drugs like potassium chlorate, sodium chloride, etc., either lessen 
or excite the tracheal and bronchial cilia, retarding or promot- 
ing expectoration of bronchial mucus. The classification usually 
adopted seems to be the most reasonable — viz. that of dividing 
expectorants into two classes: 1. Nauseant or Sedative. 2. Stim- 
ulating. 



EXPECTORANTS. 641 

Among the more important Nauseant or Sedative Expectorants 
are — 

* Alkalies ; * Ipecacuanha ; 

* Antimony and Potassium Tar- * Lobelia ; 

trate (Tartar Emetic) ; * Pilocarpus ; 

* Apomorphine ; * Potassium Iodide ; 

* Grindelia; * Quebrachos- 
all of which are considered in detail elsewhere. 

The important Stimulating Expectorants are — 

* Acids ; Oil of Scotch Fir (Oleum Pini 

* Ammonium Carbonate; Sylvestris); 
Ammonium Chloride ; Oleum Pini Pumilionis ; 

* Balsam of Peru ; Onion ; 

Balsam of Tolu ; Saccharine Substances ; 

* Benzoin and Benzoic Acid ; Senega (Saponin) ; 

* Copaiba ; * Sulphur ; 

* Cubeb ; * Squill ; 
Garlic ; Tar ; 
Liquorice ; Terebene ; 

* Nux Vomica Terpin Hydrate ; 

(Strychnine) ; * Turpentine. 

(Those marked with an asterisk (*) are elsewhere given in detail.) 

As a rule, Sedative Expectorants are permissible only in acute 
stages of bronchitis, when, as is the case in the beginning of all 
catarrhal inflammations, there is complete or partial suspension of 
function, absence of secretion, and much irritation in the bronchi, 
with distressing, harsh, and dry cough. 

In these conditions of the respiratory passages the nauseating 
sedative expectorants serve a useful purpose in lowering arterial 
tension, lessening the blood-supply to the inflamed parts, and 
increasing the secretion of mucus. 

In sufficiently large doses to produce emesis the same expecto- 
rants are frequently employed to expel an accumulation of mucus 
mechanically by the act of vomiting. 

Stimulating expectorants are more serviceable in chronic and 
relaxed conditions of the mucous membrane. They are usually 
employed to diminish or disinfect an abnormally increased secre- 
tion. These remedies generally increase blood-pressure and facili- 
tate expectoration, being eliminated to a great extent by the 
mucous membranes which they stimulate. 

41 



642 A TEXT-BOOK OF MA TERIA MEDICA. 

The alkalies are especially useful in lessening the viscidity of 
mucus, rendering it more fluid, less tenacious, and therefore more 
easily expelled. 

It requires considerable skill to combine expectorants so as to 
best suit the various conditions found in practice. The diseases of 
the respiratory passages gradually merge, so that in the treatment 
of them it is often difficult to decide which remedy will be of more 
service, a sedative or a stimulant expectorant. The physician 
should carefully examine each individual case and decide whether 
he wishes to diminish or increase the blood-supply to the respira- 
tory tract ; to stimulate or depress the respirations ; to overcome 
spasm of the bronchial muscles ; to diminish, increase, or disinfect 
the bronchial secretion. 

A thorough knowledge of the patient's condition and of the 
physiological action of the various remedies at command will 
enable the observant practitioner to combine expectorants in such 
manner as to yield ordinarily highly satisfactory results. 

Ammonii Chloridum— Ammonii Chloridi— Ammo- 
nium Chloride. U.S.I*. 

Origin. — Ammonium sulphate is first formed by neutralizing 
Gas Liquor with Sulphuric Acid. After crystallization sublime 
with Sodium Chloride. 

Description and Properties. — A white, crystalline powder, 
without odor, having a cooling, saline taste, and permanent in the 
air. Soluble in 3 parts of water ; almost insoluble in alcohol. 

Dose. — 1-30 grains (0.06-2.0 Gm.). 

Official Preparation. 

Trochisci Ammonii Chldridi — Trochiscos (ace.) Ammonii Chloridi— 
Troches of Ammonium Chloride. — Each troche contains 2 grains (0.12 Gm.). — 
Dose, 1 to 6 troches. 

Antagonists and Incompatibles. — Therapeutically, ammonium 
chloride is antagonized by the cardiac depressants. The incom- 
patibles are — alkalies, alkaline earths and their carbonates, tartaric 
acid, mineral acids, and the soluble lead and silver salts. 

Synergists. — The expectorants, emetics, and diaphoretics en- 
hance the action of the drug. 

Physiological Action. — Externally and Locally. — Ammonium 
chloride is irritant and resolvent. 



EXPECTORANTS. 643 

Internally. — In medicinal doses the drug increases the secretions 
from the gastro-intestinal glands, acting as a cholagogue. The 
solid constituents of the blood are diminished. The drug appears 
to have a special action upon the mucous membranes, augmenting 
their normal secretions and promoting nutritive changes and 
epithelial exfoliation. 

Ammonium chloride is readily absorbed, and is eliminated by 
the kidneys, skin, bronchi, and mucous membranes generally, the 
drug being a feeble diuretic, diaphoretic, and expectorant. 

Save uric acid, which is slightly diminished, all the solids of the 
urine are increased under the use of ammonium chloride. The 
drug is not considered poisonous. 

Therapeutics. — Externally and Locally. — Ammonium chloride 
possesses a wide range of therapeutic applications. Solutions of 
various strengths have proved markedly efficient as local applica- 
tions in indolent buboes, epididymitis, orchitis, bruises, inflammatory 
swellings, suppurative mastitis, etc. Senile gangrene is much bene- 
fited by immersing the foot in a bath containing 8 ounces (249.0 
Gm.) of the drug. 

A solution of 3 drachms (12.0 Gm.) of ammonium chloride to 
I pint (473.17 Cc.) of water is an efficient remedy in vaginitis. 
The lotion may be used as an injection or a tampon saturated with 
the fluid and applied to the parts. 

Lozenges, solutions, or the nascent fumes of the drug have 
been found serviceable in many diseases of the nose, throat, and 
ear, such as coryza, chronic lary7tgitis and pharyngitis, chronic aural 
catarrh, etc. 

Internally. — Few remedies are more efficient than ammonium 
chloride in bronchitis that has passed its inflammatory stage. In 
chronic bronchitis, particularly that form occurring in old people 
and persons of a feeble habit of body, the drug is veiy valuable, 
either given alone or associated with stimulant expectorants. The 
remedy has appeared to be somewhat beneficial in whooping cough. 

Ammonium chloride has been employed in intermittent 'fever and 
to promote the eruption in the exanthematous fevers. It is certainly 
of great utility in goiter, and has proved beneficial in amenorrhea 
and dysmenorrhea. It assuredly stimulates the functional activity 
of the liver, and is frequently given as a cholagogue. 

Ammonium chloride usually exerts a prompt and salutary 
action in neuralgias, particularly the neuralgia affecting the fifth 



644 A TEXT-BOOK OF MATERIA MEDIC A. 

pair, the intercostal nerves, and the sciatic nerve. The remedy has 
been also advantageously employed in myalgia and chronic mus- 
cular rheumatism. 

Contraindications. — Inflammation of the stomach, aggravated 
dyspepsia, marked emaciation, and anemia contraindicate the drug. 

Administration. — Ammonium chloride is best given in solution, 
its disagreeable taste being well disguised by the addition of some 
preparation of liquorice, such as the syrup, fluid extract, or the 
aromatic elixir of liquorice. In bronchial diseases the virtues of 
the drug are enhanced by this association. 

Balsamum Tolutanum— Balsami Tolutani— Balsam 
of Tolu. TI. S. I>. 

Origin. — A balsam obtained from Toluifera Balsamum L., an 
evergreen tree from 60 to 80 feet (18-24 M.) high, growing in the 
high, rolling country of Venezuela and New Granada. 

Description and Properties. — A yellowish-brown, semi-fluid, 
or nearly solid mass, becoming more brittle when exposed to cold ; 
transparent in thin layers, having an agreeable odor, recalling that 
of vanilla, but distinct from it, and a mild, aromatic taste ; readily 
and completely soluble in alcohol, chloroform, and solutions of the 
fixed alkalies ; almost wholly soluble in ether, but nearly insoluble 
in water or carbon disulphide. 

The drug contains a volatile oil (chiefly toluene), cinnamic and 
benzoic acids, and a resin. 

Dose. — 8-30 minims (0.5-2.0 Cc). 

Official Preparations. 

Syrupus Tolutanus — Syrupi Tolutani — Syrup of Tolu (1 per cent.). — Dose, 
2-6 fluidrachms (8-24 Cc). 

Tinctura Tolutana — Tincturae Tolutanae — Tincture of Tolu (10 per cent.). 
— Dose, Yz-i fluidrachms (2-8 Cc). 

Tinctura Benzoini CompSsita — Tincturae Benzoini CompSsitae — Compound 
Tincture of Benzoin (4 per cent.). — Described under Benzoin. 

Antagonists and Incompatibles. — Aqueous preparations are 
pharmaceutically incompatible with the tincture of tolu. 

Synergists. — The balsams, aromatic drugs, volatile oils, and 
stimulant expectorants. 

Physiological Action. — Balsam of tolu is antiseptic, disinfec- 
tant, and stimulant when applied to the skin and to raw surfaces. 
It is a pleasant carminative and stomachic. 



EXPECTORANTS. 645 

The drug is excreted principally by the mucous membranes, 
the secretions from which it stimulates and disinfects. The skin 
and kidneys also share in the excretory process. 

Therapeutics. — Inhalations of the vapor of tolu have been suc- 
cessfully employed in the treatment of chronic pharyngitis, and a 
pigment composed of 1 part of tolu to 5 parts of ether or alcohol 
has been beneficially applied to diphtheritic deposits on the tonsils 
and pharynx. 

Its agreeable flavor, together with its stimulating and expector- 
ant properties, renders tolu an efficient and eligible ingredient of 
cough mixtures, lozenges, vapors, etc. employed to modify the 
course of subacute and chronic bronchitis. 

Administration. — Tolu is usually administered in the form of 
syrup, although the tincture may be given in emulsion. Inhala- 
tions of tolu vapor are employed and lozenges containing tolu are 
frequently used. 

Allium-Allii-Garlic. U. S. P. 

Origin. — The bulb of Allium sativum L., a bulbous plant indig- 
enous in Central Asia and the basin of the Mediterranean, and 
cultivated for culinary purposes in Europe and North America. 

Description and Properties. — Bulb subglobular, compound, 
consisting of about eight compressed, wedge-shaped bulblets, 
arranged in a circle about the base of the stem and covered by 
several dry, membranaceous scales. Odor pungent and disagree- 
able ; taste warm and acrid. Garlic should be used without having 
been dried. 

The drug contains about \ per cent, of a volatile oil, to which 
its odor and taste are due. 

Dose, of bruised or chopped garlic or of the expressed juice, 
about 30 grains (2.0 Gm.). 

Official Preparation. 
Syrupus Allii— Syrupi Allii— Syrup of Garlic— Dose, 1-2 fluidrachms (4.0- 
8.0 Cc). 

Allied Species. 

Allium Cepa L. — Allii Cepae — Onion. 

Physiological Action. — Both garlic and onion are stimulants 
to the part to which they are directly applied, garlic being the 
stronger of the two. 



646 A TEXT-BOOK OF MATERIA MEDICA. 

Internally they are carminative and stomachic, and are used as 
condiments and as foods. Like all substances which stimulate the 
digestive apparatus, in excessive amounts they may occasion nausea, 
vomiting, colic, and diarrhea. 

The active constituents of these drugs are eliminated by the 
mucous membranes, skin, kidneys, and respiratory tract. The 
taste and odor of the drugs are imparted to the milk of nursing 
women. Both garlic and onion are rapidly absorbed and about as 
quickly eliminated. 

Therapeutics. — An onion poultice is a valuable domestic rem- 
edy for chronic or acute bronchitis in children, abscesses, and to 
relieve strangury when applied to the perineum, in which case it 
proves to be singularly efficient. 

The core of a roasted onion is said to quickly relieve earache 
when inserted in the auditory canal. 

Syrup of garlic or onion is an invaluable expectorant in chronic 
catarrhs of the respiratory passages in children and infants, and is 
quite an efficient remedy in the decline of whooping cough. 

A synthetical substance known as Allyl Tribromide (Tribrom- 
hydrin), closely allied to oil of garlic, has been highly recommended 
in spasmodic asthma, infantile convulsions, hysteria, angina pectoris, 
and other spasmodic disorders. It should be administered in cap- 
sules in doses 'of from 1 to 5 minims (0.06-0.3 Cc). 

Administration. — When garlic or onion is used for poultices, it 
should be boiled. 

Internally, the expressed juice made into a syrup with sugar or 
the official syrup of garlic is the form in which these drugs are 
usually given. 

Glycyrrhiza— Glycyrrhlzae— Glycyrrhiza. TJ. S. JP. 

(Liquorice Root.) 

Origin. — The root of Glycyrrhiza glabra L. and of the variety 
glandulifera (Waldstein et Killaibel) Regel et Herder, a perennial 
plant indigenous in the countries lying on the northern and south- 
ern shores of the Mediterranean and farther east through the Cau- 
casus, Northern Persia, Afghanistan, and Southern Siberia to China, 
and cultivated to some extent in England, France, Germany, and 
the United States. 

Description and Properties. — In long, cylindrical pieces from 
\ to 1 inch (6-25 Mm.) thick, longitudinally wrinkled, externally 
grayish-brown, warty ; internally tawny yellow, pliable, tough ; 



EXPECTORANTS. 647 

fracture coarsely fibrous ; bark rather thick ; wood porous, but 
dense in the narrow wedges ; medullary rays linear ; taste sweet, 
somewhat acrid. The underground stem, which is often present, 
has the same appearance, but contains a thin pith. 

The drug derived from the variety glandulifera (so-called Rus- 
sian liquorice) consists usually of roots or root-branches I to 4 
inches (2-10 Cm.) thick and 8 to 12 inches (15-30 Cm.) long, fre- 
quently deprived of the corky layer, the wood rather soft and 
usually more or less cleft. 

Liquorice contains a glucoside, glycyrrhizin, besides asparagin, 
glycyramarin, an acrid resin, starch, etc. 

Dose. — 15-60 grains (1-4 Gm.). 

Official Preparations. 

Extralctum Glycyrrhizse Fluidum — Extraxti Glycyrrhizae Fluidi — Fluid 
Extract of Glycyrrhiza. — Dose, 15-60 minims (1.0-4.0 Cc). 

Extralctum Glycyrrhizae — Extraxti Glycyrrhizae — Extract of Glycyrrhiza. — 
Dose, freely. (Extract of Glycyrrhiza is contained in Trochisci Ammonii Chloridi and 
Trochisci Glycyrrhizae et Opii.) 

Extr^ctum Glycyrrhizae Purum — Extraxti Glycyrrhizae Piiri — Pure Extract 
of Glycyrrhiza. — Dose, freely. 

Glycyrrhizinum Ammoniatum — Glycyrrhizini Ammoniati — Ammoniated 
Glycyrrhizin. — Description and Properties. — Dark-brown or brownish-red scales, with- 
out odor and having a very sweet taste ; readily soluble in water and in alcohol. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Mistura Glycyrrhizae Composita — Misturae Glycyrrhizae Compositae — Com- 
pound Mixture of Glycyrrhiza (Brown Mixture). — Formula: Pure Extract of 
Glycyrrhiza, 30; Sugar, 50; Mucilage of Acacia, 100 ; Camphorated Tincture of Opium, 
120; Wine of Antimony, 60 ; Spirit of Nitrous Ether, 30; Water, to 1000. 

Dose. — 1-4 fluidrachms (4.0-15.0 Cc). 

Ptilvis Glycyrrhizae Compfisitus — Ptilveris Glycyrrhizae Compdsiti — Com- 
pound Powder of Glycyrrhiza. (See Senna, p. 707.) 

Besides the foregoing compounds, glycyrrhiza forms a more or 
less important ingredient of eleven other official preparations. 

Physiological Action and Therapeutics. — The drug wfren 
chewed increases the flow of saliva. It is demulcent and laxative, 
and possesses slight stimulating properties when locally applied. 
It favors the secretions of the congested mucous membrane of the 
respiratory passages. 

Liquorice is used chiefly for its demulcent properties in sore 
throat, hoarseness, pharyngeal cough, acute broncliitis, etc. An in- 
fusion of the root is an agreeable and useful drink in febrile 
catarrhal affections and in irritative disorders of the boiuels and 
urinary organs attended with fever and great thirst. 



648 A TEXT-BOOK OF MA TERIA MEDICA. 

The various preparations of liquorice are serviceable in conceal- 
ing the taste of nauseous and bitter medicines and as an excipient 
for pills. 

Administration. — There are no special directions to be given — 
any of the preparations may be used. 

Oleum Pini Sylv&stris — Olei Pini Sylv&stris — Oil of Scotch Fir (unofficial). 
— Origin, Description, and Properties. — A volatile oil distilled from the leaves of Pinus 
Sylvestris, colorless, fragrant. Used by inhalation or locally. The drug is used in 
various sprays and inhalations in nasal catarrh, acute coryza, and many diseases of the 
respiratory passages. 

Oleum Templinum — Olei Templini — Oil of Pine (unofficial). — Origin, Descrip- 
tion, and Properties. — A volatile oil distilled from the shoots of Pinus Pumilio. A col- 
orless or yellowish-green oil, of an agreeable, somewhat terebinthinate odor. 

Oleum Templinum is used in the same manner and for the same purposes as Oil of 
Scotch Fir. 

PTx LIquida— PTcis Liquidae— Tar. TJ. S. JP. 

Origin. — An empyreumatic oleoresin obtained by the destructive 
distillation of the wood of Pinus palustris Miller, and other species 
of Pinus. 

Description and Properties. — Thick, viscid, semi-fluid, black- 
ish-brown, heavier than water, transparent in thin layers, becoming 
granular and opaque with age ; odor empyreumatic, terebinthinate ; 
taste sharp, empyreumatic. Tar is slightly soluble in water; solu- 
ble in alcohol, fixed and volatile oils, and solution of potassium or 
sodium hydrate. 

The drug contains many substances, chief among which are an 
empyreumatic volatile oil, pyrocatechin, acetone, xylol, toluol, 
cresols (creasote), guaiacol, phenol, etc. 

Dose. — 15-60 grains (1-4 Gm.). 

Official Preparations. 

Syrupus Picis Liquidae — Syrupi Picis Liquidae — Syrup of Tar (7.5 per cent.). 
— Dose, 1-4 fluidrachms (4.0-15.0 Cc). 

Ungu&ntum Picis Liquidae — Ungu&nti Picis Liquidae — Tar Ointment (50 
per cent.). — Used externally. 

Oleum Picis Liquidae — Olei Picis Liquidae — Oil of Tar. U. S. P. — Origin. 
— A volatile oil distilled from tar. 

Description and Properties. — An almost colorless liquid when freshly distilled, but 
soon acquiring a dark reddish-brown color and having a strong tarry odor and taste. It 
is readily soluble in alcohol. — Dose, 1-5 minims (0.065-0.3 Cc). 

Unofficial Preparations. 
Aqua Picis Liquidae — Aquae Picis Liquidae — Tar Water. — Dose, 1 pint 
(473.17 Cc.) in the course of a day. 



EXPECTORANTS. 649 

Glyceritum Picis Liquidae — Glyceriti Picis Llquidae — Glycerite of Tar. — 

Dose, \-2 fluidrachms (2.0-8.0 Cc). 

Vinum Picis (N. F.) — Vini Picis — Wine of Tar (a saturated solution in sherry 
wine). — Dose, 1-4 fluidrachms (4.0-15.0 Cc). 

Derivatives and Allied Drugs. 

Lysol. — Prepared by the action of alkalies on tar-oils and fats. A brownish, oily 
liquid with a feeble, aromatic creasote-like odor, containing 50 per cent, of cresols and 
readily miscible with water. Used as a disinfectant and antiseptic. 

Pixol. — A compound of tar soap and caustic potash or soda. Used as a disinfec- 
tant and antiseptic. 

Pix Beuilae— Picis BStulae — Birch Tar (Oleum Rusci). — Origin. — Prepared 
in Russia from the wood and bark of Betida alba L. 

Description and Properties. — Resembling wood-tar in appearance, but remaining 
liquid, and having the peculiar, penetrating odor of Russia leather, in the manufacture 
of which it is used. For the most part employed externally. 

Oleum Cadlnum — Olei Cadlni — Oil of Cade. U. S. P. — Origin. — A product 
of the dry distillation of the wood of Juniperus oxyccdrus L. 

Description and Properties. — An empyreumatic, brownish or dark-brown, clear, 
thick liquid, possessing a tarry odor and an empyreumatic, burning, somewhat bitter 
taste. Almost insoluble in water; partially soluble in alcohol. 

Dose. — 2-6 minims (0.12-0.3 Cc). Chiefly used externally. 

Antagonists and Incompatibles. — There are none of special 
importance. 

Synergists. — The aromatics, carbolic acid, creasote, and many 
of the antiseptics, turpentine, and the stimulant expectorants. 

Physiological Action. — Externally and Locally. — Tar is a stim- 
ulant, astringent, antipruritic, antiseptic, and parasiticide. It is readily 
absorbed from the skin, and when applied too freely may produce 
a papular eruption. 

Internally. — The action of tar closely resembles that of turpen- 
tine, although creosote is perhaps a more perfect analogue. Small 
doses stimulate the circulation and increase secretions generally. 
Immoderate dosage or the prolonged administration of tar impairs 
the appetite, deranges digestion, and depresses the circulatory and 
nervous systems. 

While the drug is not considered poisonous, the ingestion 
of excessive quantities of oil of tar has been attended with fatal 
results. The symptoms following imprudent dosage are nausea, 
vomiting, severe abdominal pain, diarrhea, headache, and dizziness. 
The urine is colored blackish-brown, and may contain blood or 
albumin and emit the peculiar odor of tar. There may be present 
erythema, or the skin may be covered with papules or vesicles 
attended with intense itching. 

Therapeutics. — Externally and Locally. — With the possible 



650 A TEXT-BOOK OF MA TERIA MEDICA. 

exception of sulphur and mercury, tar is the most universally- 
employed remedy for cutaneous diseases, the drug having for cen- 
turies held an important place among the efficient topical agents 
in the treatment of diseases of the skin, unhealthy ulcers, fissured 
nipples, boils, excoriations, etc. 

In chronic eczema the drug is peculiarly serviceable, and it has 
proved beneficial in chronic psoriasis and scabies. 

The oil of cade and oil of birch are used for the same pur- 
poses as tar, being usually preferred by expert dermatologists. 
The tarry preparations are valuable antipruritics, and of service in 
pruritus and various itching diseases of the skin, although their 
tendency to produce irritative and inflammatory effects when con- 
tinuously and injudiciously applied should not be overlooked. 

The benign and emollient effects of tar are best obtained when 
the drug is mixed with some soothing or astringent powder, such 
as chalk. 

The valuable properties of tar in the treatment of cutaneous 
diseases are often nullified by the ignorance of the physician and 
lack of proper administration of the drug. Prof. James Nevins 
Hyde has truthfully observed that " the skill of a physician en- 
trusted with the management of a disease of the skin might also 
be measured by his success in the use of tar." 

Lozenges containing tar, the vapor of oil of tar, and sprays 
containing tar are extensively employed in the treatment of various 
diseases of the nose and throat. 

Internally. — Tar has long possessed an enviable reputation as a 
remedy for chronic pulmonary complaints, being very efficient in 
the treatment of chronic bronchitis and the advanced stages of 
obstinate acute bronchitis, lessening the expectoration, allaying 
the oppression and distress in the chest, and soothing the cough. 
These symptoms, which attend many cases of pulmonary phthisis, 
are frequently relieved by some preparation of tar. 

Not only is this remedy of value in catarrhal conditions of the 
respiratory passages : it is equally efficient in similar conditions of 
mucous membranes elsewhere. Thus tar water has been employed 
with great benefit in gleet, leucorrhea, vesical catarrh, etc., being 
given both by the mouth and in the form of an injection. 

Administration. — Tar may be given in milk or beer or in pill 
form, although the most palatable forms are the syrup, glycerite, 
wine, and tar water, the last of which may be given to the extent 
of 1 or 2 pints (473.17 or 946.35 Cc.) daily. 



EXPECTORANTS. 651 

Senega— Senegae— Senega. V. S. J*. 

Origin. — The root of Polygala Senega L., a plant indigenous in 
North America, from Canada southward to South Carolina and 
westward to Wisconsin. 

Description and Properties. — About 4 inches (10 Cm.) long, 
with a knotty crown and spreading, tortuous branches, keeled 
when dry, fleshy and round after having been soaked in water ; 
externally yellowish-gray or brownish-yellow ; bark thick, white 
within, enclosing an irregular, porous, yellowish wood ; odor slight, 
unpleasant ; taste sweetish, afterward acrid. Senega contains sene- 
gin, also known as saponin, and polygalic acid, an acrid principle 
to which the medicinal property of the drug is due, besides a fixed 
and a volatile oil. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Official Preparations. 

ExtrSctum SSnegae Fluidum — ExtrScti SSnegae Fluidi — Fluid Extract of 
Senega. — Dose, 10-30 minims (0.6-2.0 Cc). 

Syrupus SSnegae — Syrupi SSnegse — Syrup of Senega (20 per cent, of fluid 
extract). — Dose, 30-60 minims (2.0-4.0 Cc). 

Syrupus Scillse CompSsitus — Syrupi Scillae Comp6siti — Compound Syrup 
of Squill (contains 8 per cent, of Senega). (Described under Scilla, p. 661.) 

Physiological Action. — Externally and Locally. — The active 
principle of senega is a decided irritant to the skin and mucous 
membranes, causing violent sneezing and cough, with marked 
hydremia and increased secretion from the bronchial and nasal 
mucous membranes when the powder is inhaled. 

Internally. — Digestive System. — Small doses stimulate the mu- 
cous membranes of the mouth and stomach, augmenting the sali- 
vary and gastric secretions, although frequently occasioning indi- 
gestion. Large doses irritate the alimentary canal, producing 
vomiting, diarrhea, and abdominal pain. 

Circulatory System. — The active principle of senega circulates in 
the blood unchanged, affecting the heart and blood-vessels after 
the manner of digitalis, though with less power and certainty. 

Nervous System. — Under medicinal doses no important action 
has been noted. Very large doses depress the nervous system. 

Respiratory System. — It is here that senega appears to exert its 
most important influence. The excretion of the drug through the 
bronchial mucous membrane irritates the respiratory passages, oc- 
casioning hyperemia, increased secretion, and, reflexly, cough. 

Absorption and Elimination. — The active principle of senega is 



652 A TEXT-BOOK OF MATERIA MEDICA. 

absorbed with difficulty, being excreted through the bronchial 
mucous membrane and the kidneys, irritating these structures 
during the process, and consequently acting as a stimulant, expec- 
torant, and diuretic. The drug also possesses some diaphoretic 
virtue, being partially excreted by the skin. 

Temperature. — The body-heat is uninfluenced. 

Uterus. — It is believed that senega possesses emmenagogue 
properties. 

Untoward Action. — Immoderate, and in certain susceptible sub- 
jects small, doses of senega have produced irritation and burning 
in the throat, salivation, impaired appetite, a sense of oppression in 
the stomach, nausea, vomiting, colicky pains, and profuse diarrhea. 

Poisoning. — Senega is not regarded as a poisonous drug, exces- 
sive doses producing symptoms analogous to those of " Untoward 
♦Action," save that they are intensified. 

Treatment of Poisoning. — Elimination is to be favored, and the 
symptoms treated as they appear, gastric sedatives, anodynes, and 
cardiac stimulants being employed. 

Therapeutics. — Externally and Locally. — No action has been 
observed. 

Internally. — The principal use of senega is that of a stimulating 
expectorant. The reputation of the drug originated with its 
efficacy in typhoid pneumonia, and it is still considered a valuable 
remedy in asthenic pulmonary diseases. 

It is highly beneficial in subacute bronchitis when the power to 
cough is feeble. In like manner senega is useful in bronchorrhea 
and chronic bronchitis with profuse expectoration, though less valu- 
able when the mucus is tough and scanty. 

The simple catarrhal laryngitis following croup is greatly 
relieved by the administration of senega. 

The drug is an appropriate remedy in amenorrhea the result of 
passive uterine congestion, and senegin has been recommended as 
a remedy for uterine hemorrhage. 

According to some authorities, the drug has proved beneficial 
in chronic rheumatism. 

Contraindications. — Senega is inadmissible in acute bronchitis 
and indigestion, or when there is marked irritation and inflamma- 
tion of the gastro-intestinal tract. 

Administration, — The syrup of senega is the preparation 
usually employed as an expectorant. Senegin may be given in 
doses of 2 grains (0.13 Gm.) in capsules. 



EXPECTORANTS. 653 

Terebenum— Terebeni— Terebene. U. S. -P. 

Origin. — A liquid consisting chiefly of Pinene, and containing 
only very small proportions of Terpinene and Dipentene ; obtained 
by the action of Sulphuric Acid upon Turpentine, and distillation. 

Description and Properties. — A colorless or slightly yellow- 
ish, thin liquid having rather an agreeable thyme-like odor and an 
aromatic, somewhat terebinthinate taste. Only slightly soluble in 
water, but soluble in an equal volume of alcohol. Terebene should 
be kept in well-stoppered bottles, in a cool place protected from light. 

Dose. — 5-15 minims (0.3-1. o Cc). 

Physiological Action. — When applied externally terebene acts 
as a stimulant, germicide, antiseptic, and astringent. Internally, 
small doses act as a stimulant to the gastro-intestinal tract, large 
amounts being irritant and producing effects similar to those of 
turpentine. 

The drug is eliminated by the kidneys, bronchial mucous mem- 
branes, skin, bowels, etc., acting as a mild astringent and antiseptic 
at the points of elimination. 

Therapeutics. — Externally and Locally. — The inhalation of 
terebene — 20 minims (1.23 Cc.) daily — allays the cough of laryngeal 
phthisis and has proved beneficial in irritative bronchial cough, while 
a spray of terebene mixed with oil of eucalyptus and alcohol has 
been advised in whooping cough. 

Equal parts of terebene and olive oil have been recommended 
by Vaucher and Bertin in the treatment of uterine cancer. Tere- 
bene has been successfully employed as a general antiseptic dress- 
ing of wounds, ulcers, burns, etc. 

Internally. — Whether inhaled or taken into the stomach, terebene 
is a powerful stimulant, antiseptic expectorant in chronic bronchitis. 

The drug is of service in affections of either the upper or lower 
respiratory passages. In winter cough, bronchorrhea, emphysema, 
and even in phthisis, it is an efficient remedy. 

Not only in bronchial affections is the drug valuable, but it has 
been used with striking success as a substitute for copaiba and oil 
of sandalwood in genito-urinary diseases. It has even been claimed 
to influence favorably the course of puerperal fever and to relieve 
the symptoms of flatulent dyspepsia. 

Administration. — Terebene may be given in emulsion or in 
mixtures associated with other expectorants and enclosed in cap- 
sules or dropped upon sugar. 



654 A TEXT-BOOK OF MA TERIA MEDICA. 

Terplni Hydras— Terpin i Hydratis— Terpin Hydrate. 

U. S. JP. 

Origin. — The hydrate of the diatomic alcohol Terpin, prepared by 
mixing rectified Oil of Turpentine, Alcohol, and Nitric Acid, allow- 
ing the mixture to stand for three or four days in shallow porcelain 
dishes, collecting the crystals which have formed, drying on ab- 
sorbent paper, and recrystallizing in a cold solution of alcohol. 

Description and Properties. — Colorless, lustrous, rhombic 
prisms, nearly odorless, and having a slightly aromatic and some- 
what bitter taste. Permanent in the air. Soluble in about 250 
parts of water and in 10 parts of alcohol. Terpin hydrate should 
be kept in well-stoppered bottles. 

Dose. — 2-30 grains (0,12-2.0 Gm.). 

Physiological Action. — Terpin hydrate is a powerful antiseptic, 
its action resembling that of turpentine, though inferior in strength. 

Therapeutics. — Externally and Locally. — The drug is used in 
the form of lozenges and as an inhalant in chronic tracheitis and 
chronic bronchitis. 

Internally. — Terpin hydrate may be used for the same purposes 
as terebene, being considered by some physicians superior to the 
latter drug in bronchial affections. It has been recommended as 
an efficient remedy in asthma, hay fever, nephritis, and neuralgia. 

Administration. — Terpin hydrate may be given in lozenges, 
emulsion, or aromatic elixir, although the most judicious method 
of administration perhaps is in capsules. 

Terpinol is obtained by boiling terpin hydrate with dilute mineral acids. It occurs 
as an oily body with a hyacinthine odor. Insoluble in water, but readily soluble in 
alcohol and in ether. 

Terpinol is a valuable bronchial stimulant, and may be used for the same diseases 
of the respiratory passages for which terpin hydrate is recommended. 

It is best given in capsules, in doses of about 2 grains (0.12 Gm.) each, repeated 
from four to six times a day. 



GROUP XIII.— DIURETICS 

AND SUBSTANCES ACTING ON THE KIDNEYS AND THE URINARY 

SYSTEM. 

Diuretics are drugs which increase the flow of urine. Con- 
sidered in a broader sense, however, these agents augment the 
secretion and modify the character of the urine — 

I. By increasing the amount. 



DIURETICS. 655 

2. By rendering the urine acid. 

3. By rendering the urine alkaline. 

4. By removing waste products or increasing the solid con- 
stituents of the urine. 

5. By preventing the decomposition of the urine. 

The last-named action is peculiar to benzoic * and salicylic * 
acids, cubeb, copaiba, uva-ursi, oil of sandalwood, volatile oils,* 
saccharin, and salol. 1 

The following medicines affecting the urinary system are called 
Lithontriptics , because of their power to prevent the formation of 
concretions in the urinary passages or to dissolve them when 
formed : 

Piperazin, potassium salts * lithium salts,* ammonium benzoate,* 
benzoic acid,* dilute nitric acid.* 

Among the principal drugs which render the urine acid are — 
benzoic * and salicylic * acids and many of their salts, immoderate 
amounts of the vegetable acids,* and sour wines.* 

The alkalies,* particularly the potassium and lithium salts, when 
taken internally, render the urine alkaline in reaction. 

Diuretics may be either Direct or Indirect — i. e. they may act 
on the kidneys themselves or upon certain structures outside the 
kidneys. The structures in the kidneys which have to do with 
the elimination of water, solids, etc. are — I. The Malpighian tufts, 
which eliminate principally water, but also mineral salts and certain 
pathological and foreign substances which may be present. 2. The 
glandular epithelium lining the convoluted tubules , which excretes 
waste-products, such as urea, etc. 3. The constricted portion of the 
tubules, serving to prevent (according to the Cohnheim-Bauman 
theory) the too rapid escape of water, thus allowing time for its 
absorption in cases where it is desirable that the water be retained 
in the system. 

The functional activity of these various structures is regulated by 
the nervous mechanism through its influence upon the blood-supply. 
For example, the supply of blood to the glomeruli is influenced 
largely by the size of the blood-vessels, regulated by the vasocon- 
strictor and vaso-dilator nerves ; but it has not been proven that the 
secretory cells are in any way affected by the nervous mechanism. 

Diuretics act — 

1. By increasing the general blood-pressure. 

2. By causing local dilatation of the renal arterioles. 

1 The drugs marked with an asterisk are described elsewhere in the present work. 



6 5 6 



A TEXT-BOOK OF MATERIA MEDICA. 



3. By directly stimulating the glandular secreting renal structures. 

4. By simple mechanical force. 

The following table, modified from Brunton's work on Pharma- 
cology, Therapeutics, and Materia Medica, serves to elucidate the 
methods by which the various diuretic agents probably exert their 
influence : 



Raise arterial 
pressure. 



Increased 
action. 



Generally 



cardiac f Digitalis.* 
t Alcohol * 
Digitalis,* 



Locally on kidneys. - 



Contract effer- 
ent vessels. 



Dilate efferent 
vessels. 



General vascular 
contraction. 



Act on the vaso- 
motor centers. 



__ Locally on kidney. 



Act either on vaso- 
motor centers or 
locally on renal 
vessels. 



Act on secreting 
nerves and renal 
cells. 



Increase water excreted 



Increase water and solids excreted 



By simple mechanical action 



Strophantus,* 
Squill, 
Scoparius,* 
Convallaria,* 
Strychnine,* 
Caffeine* 
Erythrophleum 
(cold to the skin). 

Same as above ? 

Scoparius,* 

Buchu, 

Uva Ursi, 

Juniper, 

Turpentine, 

Copaiba, 

Cantharides.* 

Nitrites,* 
Alcohol.* 

Urea, 
Caffeine,* 
Diuretin, 
l. Calomel.* 
Colchicum,* 
Liquor Potassae,* 
Potassium Acetate,* 
Potassium Citrate,* 
Potassium Nitrate,* 
Sodium Citrate * 

and other salines. 
Water, local bleeding, 

dry cupping, warm 

fomentations. 



The secretion of urine is considerably influenced by the activity 
of the skin and bowels ; for instance, when the cutaneous glands 
are stimulated and there is free perspiration, a diminished urinary 
secretion ensues. The functional activity of the skin and sudo- 



DIURETICS. 



657 



riparous glands depends greatly upon the amount of blood sup- 
plied to them. Whatever augments the flow of blood to these 
structures increases the secretion of the sweat-glands. Conse- 
quently, external warmth dilates the cutaneous blood-vessels and 
promotes diaphoresis, while cold contracts the cutaneous vessels, 
diverting the flow of blood to the internal organs, thereby increas- 
ing the secretion from the kidneys and lessening that from the 
skin. 

It will be seen, therefore, that the functions of the skin and 
kidneys are compensatory, the compensation being also partially 
observable in the mutual relations between the bowels and kidneys. 
It is well known that when there is active purgation, with frequent 
watery movements from the bowels, the amount of urine secreted 
is proportionally diminished. 

Any drug which increases the general blood-pressure and forces 
a larger blood-supply into the kidneys augments the pressure in 
the glomeruli, distending the capsule 
and enlarging the area of the osmotic 
membrane, which action, combined 
with an increase in the circulation, 
promotes and facilitates filtration, 
thereby augmenting the amount of 
urine. 

The membrane lining the inner 
capsule of the glomerulus is covered 
with a single layer of cubical epithe- 
lium possessing a secretory function, 
rendered more active in accordance 
with the physiological fact that the 
greater the blood-supply to a gland 
or secreting structure, the greater its 
functional activity. 

The blood-pressure in the glom- 
eruli, as has been said, may be in- 
creased by additional pressure in 
the general circulation. It may be 
raised also locally through dilatation 
of the afferent blood-vessel supply- 
ing the Malpighian corpuscle, or con- 
traction of the efferent vessels, allowing a smaller quantity of blood 
to escape from the glomerules. 
42 




Fig. 15. — A, glomerules of capillary 
blood-vessels ; B, cubical or secreting cells 
covering the membrane surrounding the 
capillary plexus ; C, space between the 
two layers opening into a convoluted tu- 
bule ; D, the external layer covered by 
flattened epithelial cells ; E, convoluted 
tubule lined with a single layer of nucle- 
ated polyhedral epithelium ; F, afferent ar- 
tery entering the Malpighian corpuscle, 
dividing in the interior into a dense, con- 
voluted capillary plexus, which finally leads 
out of the corpuscle by G, a small, efferent 
vessel comparable to a vein, at a point op- 
posite to that where the afferent vessel 
enters the Malpighian corpuscle. 



6 5 8 



A TEXT-BOOK OF MATERIA MEDIC A. 



By referring to the foregoing tabular view we may ascertain 
the drugs acting upon the general and those affecting the local 
circulation. 

The preceding diagram (Fig. 15) will serve to elucidate the 
action taking place in the glomeruli. 

The secreting structures of the convoluted tubules are stimu- 
lated by the influence of certain drugs which are carried in the 
blood, acting as excitants upon the secreting cells. This neces- 
sarily requires an extra supply of blood to the part furnishing 
material for the extra secretion. By reference to the table on 
page 656 it will be seen what diuretics act upon these struct- 
ures. 

The subjoined diagram (Fig. 16) shows the structures concerned 
with the functional activity of the kidney. 




Fig. 16. — 1, Malpighian corpuscle ; 2, convoluted tubule with capillar}' plexus from efferent vessel; 
3, constricted portion of the tubule; 4, unstriped muscle-fibers surrounding the constricted portion; 
5, afferent blood-vessel leading into the Malpighian body ; 6, effere7it vessel leading out of the Mal- 
pighian corpuscle; 7, the collecting tube. 



The imbibition of large amounts of water, while increasing the 
blood-pressure to some extent, mechanically increases the amount 
of water eliminated by the kidney. This is commonly known as 
the "flushing action," and renders the urine more dilute. 

In congested conditions of the kidneys certain remedial meas- 
ures — such as local venesection, dry cupping, warm fomentations, 
etc. — promote renal secretion. 

Therapeutics. — I. To remove excessive accumulation of fluid in 



DIURETICS. 659 

the tissues and serous cavities of the body when the blood-pressure is 
low. 

For this purpose the most efficient service is derived from the 
use of drugs which act by increasing the systemic blood-pressure, 
and stimulating the secreting cells of the kidneys. 

Ordinarily, the agents most beneficial in cardiac dropsy or drop- 
sies due to venous congestion are digitalis, calomel, scoparius, 
squill, diuretin,, etc. 

2. To remove excess of fluid from the body when the blood-pressure 
is about normal, as in cases of hepatic cirrhosis with dropsy. 

The remedies found to be most efficient in these conditions are 
diuretin, copaiba, and calomel, although frequently saline pur- 
gatives, by ridding the peritoneal cavity of excess of water and 
preventing the accumulation of fluid by lowering the abnormally 
high blood-pressure in the portal circulation, prove more beneficial 
than diuretics. 

3. To remove water from the blood when the arterial pressure is 
abnormally high. 

For this purpose diuretics are indicated in the early stages of 
many acute diseases, such as the eruptive fevers, tonsillitis, bron- 
chitis, etc. In these cases agents which dilate the cutaneous blood- 
vessels, such as spirit of nitrous ether, etc., should be employed. 
Diaphoretics and cathartics are likewise beneficial. 

4. To -remove frojn the blood injurious waste products and poi- 
sonous substances. 

For this purpose drugs which stimulate the convoluted tubules 
and increase oxidation should be given, such as potassium nitrate 
and bitartrate, the lithium salts, turpentine, juniper, diuretin, and 
the remedies mentioned under " Lithontriptics." 

The foregoing remedies will be found useful in diseases asso- 
ciated with rheumatic, gouty, and uric-acid diatheses, as well as in 
many acute diseases where there is rapid accumulation of deleteri- 
ous, retrograde material. 

5. To lessen the acidity of the uri?ie. 

The alkalies and the alkaline salts of the organic acids are the 
most useful agents for this purpose, being serviceable in such con- 
ditions as gonorrhea and acute inflammatory states o( the genito- 
urinary tract. In debilitated conditions there is quite often an ex- 
cessive acidity of the urine, irritating the mucous membrane and 
causing frequent micturition. In such cases the alkaline diuretics 
or alkaline mineral waters are of service. 



660 A TEXT-BOOK OF MA TERIA MEDICA. 

6. To increase the acidity of the urine. 

This is necessary when, from any cause, there is ammoniacal 
decomposition of the urine, as in cystitis. In such cases benzoic 
acid is probably the most beneficial remedy, though the salicylates, 
salol, and the volatile oils, etc. may also prove useful. 

J. To prevent the formation of urinary concretions or to dissolve 
them when formed, as in cases of renal calculi, etc. 

For these purposes the drugs included under " Lithontriptics " 
are the most efficient. 

8. To dilute the urine. 

This process is necessary to prevent the deposit of urinary solids 
from forming calcidi in the kidneys or bladder. For this purpose 
water or the alkaline mineral waters, taken in large quantities, will 
prove most useful. 

Administration. — Diuretics are often very uncertain in their 
action, in health many of them apparently exerting no influence 
upon the kidneys, and in diseased conditions not infrequently 
proving inert. They are more certain in their action when em- 
ployed in combination — that is, a union of drugs which act both 
generally upon the systemic circulation and locally upon the 
various secreting structures of the kidneys. Diaphoretics, being 
diverse in their action, should not be given with diuretics. 

When administered, diuretics should be freely diluted with 
water. The patient's skin should be kept cool and the bowels 
prevented from acting too freely, in order that the full benefit of 
this class of remedies may be obtained. 

The diuretic drugs not described elsewhere in the present work 
are herewith considered in detail. 

ScTIla-ScTllse— Squill. 77. S. JP. 

Origin. — The bulb of Urginea maritima (L.) Baker, a plant in- 
digenous in the basin of the Mediterranean from Syria westward to 
the coast of the Atlantic. The bulb is deprived of its dry, mem- 
branaceous outer scales and cut into thin slices, the central por- 
tions being rejected. 

Description and Properties. — Occurring in narrow segments 
about 2 inches (5 Cm.) long, slightly translucent, yellowish-white 
or reddish, brittle and pulverizable when dry, tough and flexible 
after exposure to damp air ; inodorous ; taste mucilaginous, bitter, 
and acrid. The drug contains three active principles — scillipicrin, 



DIURETICS. 66 1 

scillitoxin (both acting upon the heart), and scillin (an emetic prin- 
ciple) — together with various unimportant substances, such as mu- 
cilage, sugar, etc. 

Dose. — 1-4 grains (0.06-O.25 Gm.). 

Official Preparations. 

Acetum Scillae— Aceti Scillae — Vinegar of Squill (10 per cent.). — Dose, 10-30 
minims (0.6-2.0 Cc). 

Extractum Scillae Fliiidum — Extraxti Scillae Fluidi — Fluid Extract of 
Squill. — Dose, 1-4 minims (0.065-0.25 Cc). 

Syrupus Scillae — Syrupi Scillae — Syrup of Squill (45 per cent, of the Acetum). 
— Dose, 30-60 minims (2.0-4.0 Cc). 

Syrupus Scillae Comp6situs — Syrupi Scillae Compdsiti — Compound Syrup 
of Squill. — Dose, 15 minims-2 fiuidrachms (1.0-8.0 Cc). Fluid Extract 8 per cent., 
with Fluid Extract of Senega 8 per cent, and Tartar Emetic 2 per cent., or \ grain (.008 
Gm.) to 1 fiuidrachm (4.0 Cc). 

Tinctura Scillae — Tincturae Scillae — Tincture of Squill (15 per cent.). — Dose, 
5-20 minims (0.3-1.3 Cc). 

Antagonists and Incompatibles. — The action of squill upon 
the circulatory system is antagonized by the cardiac depressants. 
Tannic acid is incompatible. 

Synergists. — The diuretic action of squill is enhanced by the 
diuretics and many of the cardiac stimulants. As an expectorant 
the drug is aided by senega and tartar emetic. 

Physiological Action. — Externally and Locally. — There is no 
action of special importance. Applied to mucous membranes, 
however, squill acts as an irritant. 

Internally. — Digestive System. — Large doses of the drug excite 
nausea, vomiting, and purging. Excessive amounts may produce 
gastro-enteritis. 

Circulatory System. — The action of squill upon the heart and 
blood-vessels resembles that of digitalis, although as a cardiac 
stimulant digitalis is the more powerful. 

Nervous System. — Poisonous doses produce marked cerebral 
symptoms, and in warm-blooded animals may occasion paralysis 
and convulsions. 

Respiratory System. — The bronchial mucus is increased and 
expectoration facilitated by small doses of squill. Toxic doses 
render the respiration rapid and shallow. 

Absorption and Elimination. — The active principles of squill are 
quickly diffused through the blood, being eliminated chiefly by the 
kidneys and bronchial mucous membrane. 

In the passage of squill through the kidneys the renal epithe- 



66s « A TEXT-BOOK OF MA TERIA MEDICA. 

Hum is stimulated by the drug, which influence, together with the 
drug's action upon the systemic circulation, renders squill an active 
and valuable diuretic, increasing not only the amount of urine, but 
also the quantity of inorganic solids. 

Very large doses irritate and inflame the kidneys, resulting in 
strangury and hematuria, with occasionally entire suppression of 
urinary flow. 

Untoward Action. — This does not differ essentially from the 
symptoms of " Poisoning." 

Poisoning. — In toxic doses squill acts as an acro-narcotic poison. 
The symptoms produced by excessive doses are — nausea, violent 
vomiting, serous and bloody diarrhea, severe griping, a sensation 
of burning in the throat, vesical tenesmus accompanied by pain, 
bloody urine, and perhaps entire suppression of the urinary flow. 
The pulse is feeble and slow or sometimes rapid, the symptoms 
terminating in collapse and death, occasionally preceded by convul- 
sions. 

Treatment of Poisoning. — The stomach should be evacuated and 
demulcent drinks freely given. Opium may be necessary to relieve 
pain, while diffusible stimulants serve to counteract cardiac and 
respiratory depression. 

Therapeutics. — Squill is not used externally and locally. It 
has been employed internally as a diuretic in dropsy. When asso- 
ciated with digitalis and calomel it is an exceedingly active diuretic 
in cases of cardiac dropsy, chronic pleurisy, and pericarditis with 
effusion. 

Squill is an efficient expectorant, the vinegar, syrup, and com- 
pound syrup of squill being useful preparations in subacute and 
chronic forms of bronchitis, particularly when the sputum is tena- 
cious and with difficulty expelled. 

Contraindications. — Squill should not be employed in cases of 
acute diseases of the kidneys. It is also inadmissible in acute 
bronchitis and in phthisis. 

Administration. — Any of the preparations of the drug may be 
given, to be prescribed well diluted with syrup or glycerin. 

Inasmuch as the diuretic action of squill ceases after a while, 
the doses should be repeated and gradually enlarged until some 
untoward action supervenes, when further increase should be sus- 
pended. 

Because of its too irritating properties the drug is seldom given 
alone when desired for its diuretic action. 



DIURETICS. 663 

Owing to the free acetic acid which it contains, syrup of squill 
is incompatible with ammonium carbonate and other alkalies. 

Erythrophleum— Erythrophlei— Erythrophleum. 

(Casca Bark.) 

Origin. — A glucosid obtained from the bark of Erythrophlceum 
Guinense Don, known under the names of Casca bark, Sassy bark, 
and Ordeal bark. The tree is a native of West Africa, the plant 
being used by the natives as an ordeal in witchcraft. 

Description and Properties. — Erythrophlein hydrochloride, 
the salt usually employed, occurs in the form of whitish crystals, 
soluble in water. 

Dose. — GQ - 12 grain (.001-005 Gm.). 

Physiological Action and Therapeutics.^— The powdered bark 
when inhaled causes violent sneezing. The tincture of the bark, 
or the glucosid, when taken in poisonous doses occasions nausea, 
vomiting, purging, intense headache, intoxication, convulsions, and 
death. 

In medicinal doses the drug affects the circulatory system after 
the manner of digitalis, and acts upon the kidneys as an active 
diuretic. It was at one time supposed to be a powerful local anes- 
thetic; further examination, however, has proved the claim to be 
unfounded. 

Casca bark or its glucosid has been employed in intermittent 
fever, diarrhea, dysentery, and dyspepsia. Its chief medical uses 
are in valvular diseases of the heart and as a diuretic in cardiac 
and renal dropsies. 

Administration. — A tincture of the bark (10 per cent, strength) 
may be given internally, diluted with water, in doses of 5-10 min- 
ims (0.3-0.6 Cc). Erythrophlein hydrochlorate is usually given 
hypodermically. 

Buchu— BGchu— Buchu. V. S. JP. 

Origin. — The leaves of Barosma betulina (Thunberg) Bartling 
et Wendland, and Barosma crenulata (L.) Hooker, plants or shrubs 
attaining a height of several feet, indigenous in the southern por- 
tion of Africa, particularly in various parts of Cape Colony. 

Description and Properties. — The leaves are -| to f inch (12 
to 19 Mm.) long, roundish-obovate, with a rather wedge-shaped 
base, or varying between oval and obovate, crenate or serrate, with 
a gland at the base of each tooth, dull yellowish-green, thickish, 



664 A TEXT-BOOK OF MATERIA MEDIC A. 

pellucid-punctate ; odor and taste strongly aromatic, somewhat 
mint-like, pungent, and bitterish. Buchu contains from I to 1.56 
per cent, of a volatile oil, which, on exposure to a low temperature, 
releases barosma camphor or diosphenol, a stearopten. The bitter 
principle of buchu is rutin ; resin is also present. 
Dose. — 15-30 grains (1.-2. Gm.). 

Official Preparation. 
Extractum Buchu Fluidum — Extr&cti Buchu Fluidi— Fluid Extract of 
Buchu. — Dose, 15-30 minims (1-2.Cc). 

Physiological Action and Therapeutics. — Externally and 
locally buchu has no action of importance. When ingested it 
acts as a carminative, in small doses occasioning a feeling of 
warmth, but in excessive doses acting as an irritant. 

Upon the circulation the influence of the drug is that of a mild 
stimulant. 

Its active constituents are rapidly diffused through the blood, 
and are eliminated principally by the kidneys, the bronchial mucous 
membrane sharing in the excretory process. 

Buchu increases the fluid and solid constituents of the urine, 
imparting to it a peculiar aromatic odor. The drug acts as a tonic 
astringent and disinfectant to the mucous membranes, from which 
it is eliminated, diminishing the secretions. 

If taken for too long a period, irritation and inflammation of the 
kidneys are apt to ensue because of excessive stimulation. 

The drug is chiefly employed as a stimulant diuretic and expecto- 
rant in catarrhal conditions of the genito-urinary organs and bron- 
chial tubes. Buchu is therefore of service in urethritis, gonorrhea, 
gleet, chronic cystitis, incontinence of urine due to want of muscular 
tone, pyelitis, etc. The drug has also proved beneficial in certain 
cases of chronic bronchitis, and has even been recommended in 
chronic rheumatism and lithemia. 

Contraindications. — Buchu is contraindicated in acute inflam- 
mation of the kidneys. 

Administration. — The fluid extract and the infusion are the 
only preparations employed. They should be given freely diluted 
with water. 

Ova Ursi— Uvse Ursi— Uva Ursi. V. S. P. 

(Bearberry.) 
Origin. — The leaves of Arctostaphylos Uva Ursi (L.) Sprengel., 
a trailing evergreen plant distributed throughout the northern por- 



DIURETICS. 665 

tion of North America, extending as far south as New Jersey and 
westward to Colorado. The plant is also found in most parts of 
Europe and in Northern Asia. 

Description and Properties. — Leaves very short-stalked, 
obovate or oblong-spatulate, coriaceous, about |- inch (2 Cm.) long 
and \ to \ inch (6 to 8 Mm.) wide, obtuse, with slightly revolute 
edges, upper surface with depressed veins, lower surface distinctly 
reticulate; odor faint, hay-like; taste strongly astringent and some- 
what bitter. 

Uva ursi contains three glycosides, arbutin, methylarbutin, and eri- 
colin, and a tasteless principle, urzone, besides tannic and gallic acids. 

Dose. — 15-60 grains (1.-4. Gm.). 

Official Preparations. 

Extractum Uvae Ursi — Extr^cti Uvae Ursi — Extract of Uva Ursi. — Dose, 
5-15 grains (0.3-1.0 Gm.). 

Extr&ctum Uvae Ursi Fluidum— ExtrScti Uvae Ursi Fluidi— Fluid Extract 
of Uva Ursi. — Dose, 15-60 minims (1-4 Cc). 

The Physiological Action and Therapeutics of uva ursi are anal- 
ogous to those of buchu. The arbutin and methylarbutin are capable 
of being split into glucose and hydrochinon or methylhydrochinon, 
to which latter substances the antiseptic action of this drug is due. 

Juniperus— Junlperi— Juniper. 

(Juniper Berries.) 

Origin. — The fruit of Juniperus communis (L.), an evergreen 
tree indigenous in the northern hemisphere and found in the 
United States and Canada and in Europe. 

Description and Properties. — Berries globular, about the size 
of a large pea, externally of a glossy, purplish-black color, covered 
with a grayish bloom. They have an aromatic, balsamic odor, and 
a sweet terebinthinate, bitterish, and slightly acrid taste. Juniper 
contains a volatile oil ; also juniperin, sugar, wax, fat, etc. 

Dose. — 15-60 grains (1.-4. Gm.). 

Oleum Junlperi— Olei Junlperi— Oil of Juniper. 

IT. S. JP. 

Origin. — A volatile oil distilled from the fruit of Juniperus 
communis. 

Description and Properties. — A colorless or faintly greenish- 
yellow liquid, becoming darker and thicker through age and 



666 A TEXT-BOOK OF MA TERIA MEDICA. 

exposure to air, having the characteristic odor of juniper and 
a warm, aromatic, somewhat terebinthinate and bitterish taste. Sol- 
uble in about four times its volume of alcohol, forming a more or 
less turbid liquid, which is neutral or slightly acid to litmus-paper. 
Dose. — 5-15 minims (0.3-1.0 Cc). , ■ 

Official Preparations. 

Spiritus Juniperi— Spiritus Juniperi— Spirit of Juniper.— Dose, 1-8 fluidrachms 
(4.0-30.0 Cc). Formula: Oil of Juniper, 5; Alcohol, 95 parts. 

Spiritus Juniperi Comp&situs— Spiritus Juniperi Comp6siti— Compound 
Spirit of Juniper.— Formula : Oil of Juniper, 8 ; Oil of Caraway, I ; Oil of Fennel, 
I; Alcohol, 1400; Water sufficient to make 2000 parts.— Dose, 2-4 fluidrachms 
(8.0-15.0 Cc). 

Unofficial Preparations. 

Extr&ctum Juniperi Frtictus Fluidum— ExtrScti Juniperi Frtictus Fluidi— 
Fluid Extract of Juniper Berries. — Dose, 15-60 minims (1.0-4.0 Cc). 

Infusum Juniperi — Infusi Juniperi — Infusion of Juniper. — 1 ounce (31. Gm.) 
of Juniper to I pint (473. Cc.) of Water. — Dose, 2-4 fluidounces (60.-118. Cc). 

Physiological Action and Therapeutics. — Juniper in its action 
resembles buchu, being a stimulant diuretic. Under certain condi- 
tions it acts as a diaphoretic. It is a tonic to the stomach and 
a mild aphrodisiac. 

The volatile oil, which is the active constituent of juniper, 
diffuses through the blood with great facility, stimulating the heart, 
and, in dropsical conditions, increasing the flow of urine. In 
health, however, the amount of urine is diminished, while that 
of urea is augmented. 

Juniper is used for the same purposes as buchu — being superior 
to the latter drug perhaps — especially in various dropsies and 
passive congestion of the kidneys. 

Contraindications. — The same as for buchu. 

Administration. — Any of the preparations may be given, gin 
being a popular diuretic. 

Oleum Terebinthlnae— Olei Terebinthlnae— Oil of 
Turpentine. TI. S. JP. 

Origin. — A volatile oil distilled from turpentine — a concrete 
oleoresin obtained from Pinus palustris Miller and other species 
of Pinus. 

Description and Properties. — A thin, colorless liquid, of a 
characteristic odor and taste, both of which become stronger and 
less agreeable with age and exposure to air. Soluble in three 



DIURETICS. 667 

times its volume of alcohol. Oil of turpentine should be kept 
in well-stoppered bottles, protected from light. 
Dose. — 5-15 minims (0.3-1.0 Cc), in emulsion. 

Official Preparations. 

Linirngntum Terebinthinae — LinimSnti Terebinthinae — Turpentine Lini- 
ment (35 per cent, with resin cerate). For external use. 

Oleum Terebinthinae Rectificatum — Olei Terebinthinae Rectificati — Rec- 
tified Oil of Turpentine. — Dose, 5-15 minims (0.3-1.0 Cc). 

Antagonists and Incompatibles. — The motor depressants and 
agents increasing waste therapeutically antagonize the action of 
turpentine. Bromine, iodine, and nitric and sulphuric acids are 
incompatible, explosion occurring with the first two, and combus- 
tion taking place by mixture with the acids named. 

Synergists. — The therapeutic actions of turpentine are enhanced 
by buchu, cubeb, copaiba, oil of sandalwood, and the diffusible and 
alcoholic stimulants. 

Physiological Action. — Externally and Locally. — Oil of turpen- 
tine is antiseptic, hemostatic, irritant, counter-irritant, rubefacient, 
vesicant, and a parasiticide. Its action resembles closely that of 
the volatile oils as described under " Aromatics." 

When applied to the epidermis the drug dilates the cutaneous 
blood-vessels, occasioning a sensation of heat and producing red- 
ness of the skin, and, if the oil be applied with inunction for any 
length of time, vesication ensues, with, occasionally, intractable 
ulcerations. The fumes of oil of turpentine when inhaled cause 
great irritation of the eyes and the respiratory passages. 

The drug is readily absorbed from the unbroken skin. 

Internally. — Digestive System. — When taken into the mouth 
turpentine produces a burning, pungent taste and an immediate and 
augmented salivary secretion. Swallowed in immoderate amounts, 
the drug occasions a sensation of heat in the epigastrium, with in- 
creased peristaltic action and secretion. The intestines are simi- 
larly affected, the intestinal peristalsis being greatly augmented, the 
drug acting as an efficient carminative. 

Large doses of turpentine produce severe, burning pain in the 
stomach and bowels, accompanied by nausea, vomiting, and purg- 
ing, the feces often containing blood. 

The drug is an efficient anthelmintic for tape-worm. 
Circulatory System. — Turpentine is a cardiac stimulant, increasing 
the force and rapidity of the heart's action and raising arterial ten- 



668 A TEXT-BOOK OF MATERIA MEDICA. 

sion by direct cardiac influence. The blood-vessels are contracted 
by the drug, which may account for its hemostatic properties. 
Very large doses slow the heart by stimulating the vagus inhibitory 
center. 

Nervous System. — Small doses increase and large doses dimin- 
ish reflex excitability. Large doses produce giddiness, mental 
exhilaration, and incoherence of ideas, followed by dulness and 
occasionally coma. 

There is incoordination of movements, resulting in unsteady 
gait, great muscular weakness, and diminished sensation, usually 
preceding the impairment of voluntary motion. 

Respiratory System. — The effect of inhaled oil of turpentine on 
the respiratory passages has been described. When ingested the 
drug increases and disinfects the bronchial secretion. Small doses 
increase and large doses diminish the respiratory movements. 

Absorption and Elimination. — Oil of turpentine is rapidly diffused 
in the blood, in moderate doses stimulating the kidneys and in- 
creasing the flow of urine, to which it imparts the odor of violets. 
Large doses irritate the kidneys, lessening the amount of urine, 
rendering it highly colored, and in some cases producing albu- 
minuria, hematuria, and even total suppression. There are present 
priapism and a frequent desire to micturate. 

Turpentine is rapidly eliminated from the system, not only by 
the kidneys, but by the skin, and bronchial and intestinal mucous 
membranes as well. 

Temperature. — The drug is a mild antipyretic. 

Untoward Action. — Erythema and eczematous eruptions are 
produced by both the ingestion and the local application of turpen- 
tine. In susceptible individuals small doses may occasion serious 
disturbances of the genito-urinary and gastro-intestinal tracts, such 
as strangury, painful erections, salivation, and stomatitis. 

The administration of repeated doses of oil of turpentine may 
produce peculiar nervous manifestations, such as headache, drowsi- 
ness, dizziness, and a sense of mental vacuity. 

Poisoning. — Few cases are recorded of death resulting from the 
ingestion of excessive amounts of turpentine, owing to the fact 
that the greater amount of the drug passes away through the 
bowels. 

The symptoms produced by very large doses are — great mus- 
cular weakness, abolition of reflexes, and violent vomiting and 
purging, with bloody evacuations from the bowels. There is great 



DIURETICS. 669 

irritation of the genito-urinary tract, with constant efforts to mic- 
turate, hematuria or entire suppression of urine, painful priapism, 
and violent strangury. 

The skin is moist, and the face flushed or cyanosed, while dila- 
tation of the pupils, slow, labored, and stertorous breathing, and 
occasionally paroxysms of convulsive coughing, may be attendant 
symptoms. v 

Either great mental excitement or profound insensibility may be 
present. The heart and circulatory system are greatly depressed, 
death, when occurring, being usually the result of cardiac failure. 

Treatment of Poisoning. — The stomach should be at once evacu- 
ated, and elimination favored by every possible means. The free 
administration of demulcent drinks is advisable, while to relieve 
pain opium may be given. Other symptoms should be treated 
according to their indications. 

Therapeutics. — Externally and Locally. — Oil of turpentine is 
an efficient counter-irritant, being employed as such in lumbago, my- 
algia, neuralgia, rheumatic pains, bronchitis, pleurisy, and various 
forms of chronic inflammation. A turpentine stupe is perhaps the 
most effective method in the local application of the drug. It is 
applied as follows: (1) A flannel is wrung out of hot water, 
sprinkled well with the oil and allowed to remain in contact with 
the affected part from five to twenty minutes, as indicated by the 
sensibility of the skin. Care must be taken in the preparation of 
the flannel lest the patient be chilled or scalded. (2) A vessel 
containing the oil is placed in hot water and a flannel wrung from 
the oil applied as desired. 

A turpentine stupe is perhaps the most grateful and efficient 
local application in peritonitis. 

Owing to its antiseptic and hemostatic properties the oil of 
turpentine is frequently and beneficially employed as a dressing 
for lacerated wounds. 

The drug is an active parasiticide, and has been used success- 
fully in the treatment of tinea tonsurans, etc. It has also been 
favorably recommended, when diluted with some bland oil, as a 
remedy for alopecia areata and psoriasis. 

Turpentine serves a useful purpose in many diseases of the ear 
and throat. 

Cecchini uses turpentine in the treatment of caries of the tem- 
poral bone. 

J. Solis Cohen recommends the vapor of turpentine as an 



670 A TEXT-BOOK OF MATERIA MEDICA. 

efficient means of allaying the cough and irritation occasioned by 
acute laryngeal catarrh. 

Erichsen employs the drug as a hemostatic to check bleeding 
after excision of the tonsils. 

The inhalation of the oil of turpentine lessens pulmonary 
hyperemia and excessive bronchial secretion. 

The drug has been recommended as a local application in 
diphtheria after the removal of the membranes. 

Internally. — Turpentine is a valuable remedy for gastric or 
intestinal flatulence, particularly when the condition arises from 
an atonic state of the muscles of the stomach or intestines. 

The drug is frequently employed in typhoid fever, not only for 
the relief of tympanitis, but also to check intestinal hemorrhage. 

In chronic intestinal catarrh, as well as in a catarrhal condi- 
tion of any mucous membrane, turpentine is a valuable remedial 
agent. 

The drug is an effectual hemostatic when given internally, 
having been successfully employed in hemoptysis, hematemesis, 
hematuria, menorrhagia, purpura hemorrhagica, etc. 

Turpentine is a very powerful anthelmintic against tape-worm. 
When given for this purpose it should be administered in a single 
large dose, from 4-8 fluidrachms (1 5.-30. Cc), together with a 
large dose of some purgative like castor-oil to ensure the prompt 
elimination of the turpentine from the bowels. 

As a cardiac stimulant turpentine is often employed in low and 
depressed conditions of the circulatory system, such as typhoid, 
yellow, and puerperal fevers, pneumonia, capillary bronchitis, trau- 
matic erysipelas, etc. 

As has been suggested, the drug has a decided and beneficial 
influence upon relaxed and chronic catarrhal conditions of mucous 
membranes, rendering this remedy of great value in bronchorrhea, 
chronic bro?tchitis, emphysema with marked bronchial catarrh, etc. 
This action upon the mucous membranes, together with the diu- 
retic properties of the drug, renders turpentine an exceedingly 
valuable remedy in the treatment of gleet, subacute gonorrhea, 
chronic cystitis, spermatorrhea, prostatorrhea, pyonephrosis, etc. 

Old ozonized oil of turpentine is one of the best antidotes 
and prophylactics in cases of phosphorus-poisoning. 

So-called atonic incontinence of urine is frequently benefited by 
the drug ; and Durand has highly recommended oil of turpen- 
tine as a solvent of biliary calcidi. 



DIURETICS. 671 

Contraindications. — Oil of turpentine should never be given 
to patients suffering from Bright's disease or acute inflammation 
of the gastro-intestinal and genito-urinary tracts. 

The drug should be withheld in cases of active hemorrhage in 
plethoric subjects ; and, while some authorities recommend turpen- 
tine in hematuria, others class this condition as a contraindication. 
If given in the latter condition, the dose should be small and 
cautiously repeated. 

Administration. — Small doses of turpentine may be given on 
lumps of cut sugar, but usually preference is given to administra- 
tion in the form of a capsule or an emulsion, 1 fluidrachm (4. Cc.) 
of mucilage of acacia, if properly manipulated, emulsifying \ fluid- 
drachm (2. Cc.) of oil of turpentine with 1 fluidounce (30. Cc.) of 
water. Flavoring substances can be incorporated in the emulsion, 
rendering the preparation not unpleasant to the taste. 

In giving turpentine its tendency to produce untoward manifes- 
tations, particularly of the genito-urinary tract, should be remem- 
bered, care being invariably exercised in the administration of the 
drug. 

For external use the drug may be used in full strength, diluted 
with some bland oil or ointment, or applied in the form of stupes. 

Turpentine is sometimes employed as an enema, in which case 
it should, of course, be mixed with some bland oil and mucilage 
of acacia in the form of an emulsion. 



Copaiba— Copaibae— Copaiba. U. S. JP. 

(Balsam of Copaiba.) 

Origin. — The oleoresin of Copaiba Langsdorffii (Desfontaines) 
O. Kuntze, and other species of Copaiba, lofty forest trees, natives 
of Central America. 

Description and Properties. — A transparent or translucent, 
more or less viscid liquid of a pale-yellow to brownish-yellow 
color, having a peculiar aromatic odor and a bitter acrid taste. 
Insoluble in water ; readily soluble in absolute alcohol, ether, chlo- 
roform, carbon disulphide, benzin, and fixed and volatile oils. 

Copaiba contains a volatile oil, two resins, copaibic acid (soluble 
in absolute alcohol and in ammonia), and a bitter principle. The 
term " balsam " is a misnomer, since the drug contains neither 
benzoic nor cinnamic acid. 

Dose. — 5-30 minims (0.3-2.0 Cc), in emulsion or in capsule. 



672 A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparation. 

MSssa Copaibae — M&ssae Copaibae — Mass of Copaiba. — Formula : Copaiba, 
94; Magnesia, 6; Water, a sufficient quantity. — Dose, 5-30 grains (0.3-2.0 Gm.). 

Oleum Copaibae— Olei Copaibae— Oil of Copaiba. 

TJ. S. JP. 

Origin. — A volatile oil distilled from Copaiba. 

Description and Properties. — A colorless or pale-yellowish 
liquid, having the characteristic odor of copaiba and an aromatic, 
bitterish, and pungent taste. Soluble in about ten times its volume 
of alcohol, forming a slightly turbid liquid, which is neutral to 
litmus-paper. The drug should be kept in well-stoppered bottles, 
in a cool place. 

Dose. — 5-15 minims (0.3-1 Cc). 

Reslna Copaibae— Reslnae Copaibae— Resin of 
Copaiba. U. S. P. 

Origin. — The residue left after distilling off the volatile oil from 
Copaiba. 

Description and Properties. — A yellowish or brownish-yellow, 
brittle resin, having a slight odor and taste of copaiba. Soluble in 
alcohol, ether, chloroform, carbon disulphide, benzol, and amylic 
alcohol. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Antagonists and Incompatibles. — Copaiba is antagonized by 
the same drugs which antagonize turpentine. It is pharmaceuti- 
cally incompatible with aqueous preparations. 

Synergists. — The same as for turpentine. 

Physiological Action. — Externally and Locally. — Copaiba has 
no influence of importance, being but slightly stimulant to the 
skin. 

Internally. — Digestive System. — Its action is analogous to that 
of turpentine and the volatile oils. The ingestion of the drug, 
even in small doses, is almost always succeeded by eructations 
tasting of copaiba. 

Copaiba exerts no special influence upon the circulatory, ner- 
vous, and respiratory systems. 

Absorption and Elimination. — The drug enters the circulation 
with facility, and is slowly eliminated by the skin and mucous 
membranes generally, although chiefly by the kidneys. The resin 
which the drug contains is a powerful stimulant of the genito- 



DIURETICS. 673 

urinary structures, increasing the quantity, and to some extent the 
solid constituents, of the urine. Large doses irritate the kidneys, 
occasionally producing strangury, bloody urine, pain in the blad- 
der, etc. 

Under the use of copaiba albumin is sometimes found in the 
urine. Frequently the nitric-acid test with urine may give a reac- 
tion as if for albumin, the conclusions being then erroneous, since 
the resin of copaiba eliminated in the urine is by the action of 
nitric acid precipitated as a milky cloud, readily differentiated from 
albumin by heating the urine or mixing it with alcohol, by both of 
which means the resinous precipitate is dissolved. 

Copaiba acts as a stimulant and disinfectant at the points of 
elimination, in medicinal amounts increasing secretion and impart- 
ing to the secretion from the kidneys, bronchial mucous membrane, 
and skin a peculiar, fragrant odor. 

Untoward Action. — It often happens that after a few days' ad- 
ministration of copaiba there is produced in certain individuals an 
eruption, usually resembling roseola, which later may be trans- 
formed into true papules. Or the eruption may be scarlatiniform 
in character or a true eczema ensue. These eruptions are first 
noticeable on the upper and lower extremities, backs of the hands 
and knees, malleoli, etc., and are attended with intense itching. 

Under the prolonged use of the drug there may occur serious 
disturbances of the digestive and genito-urinary tracts. 

Poisoning. — In addition to the untoward manifestations already 
mentioned, very large doses of copaiba produce symptoms similar 
to those described under Turpentine. Cases have been recorded 
in which excessive amounts occasioned paralysis and tetanoid 
attacks. 

Treatment of Poisoning. — This should be the same as prescribed 
under Turpentine. 

Therapeutics. — Externally and Locally. — The use of copaiba 
has recently been revived by Dr. Beach of Boston as a protectant 
antiseptic and antiphlogistic dressing for the treatment of chroiiic 
and indolent ulcers. 

It has been advocated as an excellent application in many 
chronic diseases of the skin, such as psoriasis, lupus, etc. The 
drug has proved valuable in frost-bites, while Shoemaker mentions 
it as a useful remedy to apply to " thickened and irritable conditions 
of the to?igue, mouth, rectum, vagina, uterus, and urethra!' The 
same authority affirms that the drug sometimes completely re- 

43 



674 A TEXT-BOOK OF MA TERIA MEDICA. 

moves the discharge of gleet when applied directly to the ure- 
thra. 

Internally. — The principal use of copaiba is as a stimulant and 
disinfectant of the genito-urinary tract in cases of gleet, subacute 
gonorrhea, vaginitis, cystitis, pyelitis, etc. 

In ascites and dropsical conditions, particularly those due to 
hepatic and cardiac disease, the resin of copaiba proves a very 
efficient and reliable diuretic. Under prolonged use, however, a 
tolerance appears to be established. 

Copaiba is a valuable remedy in chronic bronchitis and bronchor- 
rhea with offensive expectoration. 

The drug has been at times given internally with good results 
in psoriasis, urticaria, etc., although the internal use of copaiba in 
these disorders is less common than formerly. 

The drug has found enthusiastic advocates as a remedy in 
chronic diarrhea and dysentery, and has also been recommended 
in chronic proctitis and chronic intestinal catarrh. 

Contraindications. — The same as for turpentine. 

Administration. — The methods of administration recommended 
for turpentine are applicable to this drug. It is claimed that many 
of the untoward manifestations produced by copaiba may be pre- 
vented by giving the drug with an alkali. With this object in 
view copaiba was associated with magnesia in the " Massa Copaibae." 
Yet, while this preparation is perhaps less likely to produce unto- 
ward results, it is undoubtedly less active therapeutically than the 
single drug. 

Oleum Santali— Olei Santali— Oil of Santal. 

XT. S. JP. 

(Oil of Sandalwood.) 

Origin. — A volatile oil distilled from the wood of Santalum 
album L., a small tree indigenous in Southern India and portions 
of the East Indies. 

Description and Properties. — A pale-yellowish or yellow, 
somewhat thickish liquid, having a peculiar, strongly aromatic 
odor and a pungent, spicy taste ; readily soluble in alcohol. It is 
frequently adulterated with oil of cedar. 

Dose. — 5-20 minims (0.3-1.2 Cc). 

Physiological Action and Therapeutics. — The action of oil of 
sandalwood resembles closely that of copaiba, and it may be given 
for the same purposes as the latter drug, although oil of sandal- 



DIURETICS. 675 

wood is more popular, and ordinarily a more efficient remedy, for 
gonorrhea, particularly in the early stages. 

Administration. — The same as in the case of copaiba. 

Cubeba— Cubebae— Cubeb. XT. S. JP. 

Origin. — The unripe fruit of Piper Cubeba Linn, fil, a climbing 
diecious shrub about 20 feet (6 M.) high, indigenous in Java. 

Description and Properties. — Globular, about \ or \ inch 
(4 or 5 Mm.) in diameter, contracted at the base into a rounded 
stipe about \ or -J inch (6 or 10 Mm.) long, reticulately wrinkled, 
blackish-gray, internally whitish and hollow; odor strong, spicy; 
taste aromatic and pungent. It contains from 5 to 15 per cent, 
of a volatile oil, an odorous principle, cubebin, and a diuretic prin- 
ciple, cubebic acid, besides resin, fat, wax, and starch. 

Dose. — 5-60 grains (0.32-4.0 Gm.). 

Official Preparations. 

Extralctum Cubebae Fluidum — ExtrScti Cubebae Fluidi — Fluid Extract of 
Cubeb. — Dose, 5-60 minims (0.32-4.0 Cc). 

Oleoresina Cubebae — Oleoresinae Cubebae — Oleoresin of Cubeb. — Dose, 15^ 
30 minims (0.32-2.0 Cc). 

Tinctiira Cubebae — Tinctiirae Cubebae — Tincture of Cubeb (20 per cent.). 
— Dose, y 2 -2. fluidrachms (2.0-8.0 Cc). 

Trochisci Cubebae — Trochiscos (ace) Cubebae — Troches of Cubeb. (Each 
troche contains % minim (.043 Cc.) of the oleoresin.) — Dose, 1 to 6 troches. 

Oleum Cubebae— Olei Cubebae— Oil of Cubeb. 

U. S. P. 

Origin. — A volatile oil distilled from Cubeb. 

Description and Properties. — A colorless, pale-greenish, or 
yellowish liquid, having the characteristic odor of cubeb and 
a warm, camphoraceous, aromatic taste. Soluble in an equal 
volume of alcohol. It should be kept in well-stoppered bottles, 
in a cool place, protected from light. 

Dose. — 5-15 minims (0.3-1.0 Cc). 

Antagonists and Incompatible^ — The motor depressants an- 
tagonize the action of cubeb. 

Synergists. — Buchu, copaiba, oil of santal, black pepper, and 
many of the aromatics and volatile oils. 

Physiological Action. — Externally and Locally. — Like the 
aromatics and drugs containing a volatile oil, cubeb is irritant and 
rubefacient when applied by inunction. 



676 A TEXT-BOOK OF MA TERIA MEDICA. 

Internally. — Digestive System.- — In medicinal amounts cubeb is 
an aromatic stomachic, increasing the appetite and improving 
digestion. As is the case with other drugs of this class, large dos- 
age or the too prolonged use of small amounts irritates the stomach 
and deranges digestion, cubeb acting as a laxative and occasioning 
a sensation of heat and discomfort about the rectum. 

Circulatory System. — Like other members of the Pepper family, 
cubeb enters the blood with facility, and increases the force and 
frequency of the heart's action. 

Nervous System. — No important action has been noted. 

Respiratory System. — There is no perceptible effect when the 
drug is given in medicinal doses. 

Absorption and Elimination. — Cubeb is absorbed and eliminated 
with considerable rapidity. It escapes from the system chiefly by 
the urine, though the skin and bronchial mucous membrane share 
in the excretory process. The drug acts as an active stimulant 
and disinfectant to the structures by which it is excreted, and is 
consequently a diuretic expectorant and mild diaphoretic. 

The urine and the amount of uric acid are increased by cubeb, 
the drug appearing in the urine as a salt of cubebic acid, which 
may be precipitated by nitric acid, the precipitate resembling that 
of albumin. 

Untoward Action. — Cubeb occasionally produces great disturb- 
ance in the gastro-intestinal tract, colicky pains, and diarrhea. 
The most frequent untoward manifestations, however, are various 
cutaneous eruptions, appearing in the form of papules, and often- 
times as a diffuse erythema. No febrile symptoms attend these 
eruptions, which usually disappear shortly after the suspension of 
the drug. 

Poisoning. — Although cubeb is not regarded as a poison, very 
large doses may be followed by all the symptoms of severe gastro- 
intestinal irritation. 

Treatment of Poisoning. — The indications are to empty the 
stomach, favor elimination, and treat the patient symptomatically 
by the use of demulcents, anodynes, stimulants, etc., as necessary. 

Therapeutics. — Externally and Locally. — The drug is a de- 
servedly popular remedy in many diseases of the nose and throat. 
The insufflation of an impalpable powder of cubeb or the inhala- 
tion of smoke from the burning drug is an efficient palliative to the 
sense of oppression arising from turgescence of the nasal mucous 
membrane. 



DIURETICS. 6/y 

The troches of cubeb are extensively used for coughs, hoarse- 
ness, etc. The oil of cubeb is used as an inhalant and as a local 
application in many diseases of the throat and respiratory passages. 

Internally. — Cubeb is used internally for about the same pur- 
poses as copaiba, although by many physicians considered to be 
inferior to the latter drug in genito-urinary disorders. 

Contraindications. — The same as for copaiba. 

Administration. — Any of the preparations may be given. The 
oleoresin is best administered in capsules or emulsion. 



Diuretin— Diuretin— Diuretin. 

(SODIO-SALICYLATE OF THEOBROMINE.) 

Origin. — The name indicates the origin, the drug being a chemi- 
cal combination of Theobromine (49.7 per cent.) and Salicylic 
Acid (38.1 per cent). It is, in reality, a mixture of Theobromine 
and Sodium Salicylate. 

Description and Properties. — A white powder, soluble in less 
than half its weight of hot water, the solution remaining perfect on 
cooling. Sparingly soluble in cold water ; soluble in warm alco- 
hol ; insoluble in chloroform or ether. The drug has a disagree- 
able, soap-like taste, and undergoes decomposition when exposed 
to the air. 

Dose. — 15 grains (1.0 Gm.); 45 to 105 grains (2.9-7.0 Gm.) 
may be given in divided portions in twenty-four hours. 

Antagonists and Incompatibles. — The properties of diuretin 
being as yet imperfectly known, it is impossible to enumerate all 
the antagonists, incompatibles, and synergists. The action of the 
drug would certainly be retarded by the cardiac and motor de- 
pressants. Acids, both mineral and vegetable, are incompatible. 

Synergists. — The therapeutic influence of the drug would 
theoretically be enhanced by caffeine, digitalis, and many of the 
cardiac stimulants and diuretics. 

Physiological Action. — Externally and Locally. — There is none. 

Internally. — Digestive System. — Diuretin has no important ac- 
tion, though in many cases it may cause disturbance of digestion, 
impair the appetite, and even occasion nausea, vomiting, and 
diarrhea. 

Circulatory System. — The drug has a very beneficial action 
upon the system in failing compensation and edema, its favorable 



678 A TEXT-BOOK OF MATERIA MEDICA. 

influence being due to its effect upon the kidneys. Theobromine, 
like caffeine, exercises a direct, stimulating action upon the renal 
epithelium and also a stimulating effect upon the vaso-motor 
center in the medulla. While we should expect a marked diuretic 
action from the drug, such is not always the case, because of its 
vaso-motor influence in contracting the vessels of the kidney. The 
vaso-motor action, however, is remedied by the presence of the 
salicylate, leaving the blood-supply to the kidney increased, 
through the functional activity of the cells. 

Nervous System. — Large and continued doses frequently occa- 
sion headache, somnolence or insomnia, with buzzing in the ears, 
and symptoms resembling those produced by the salicylates. 

Respiratory System. — Diuretin exerts no direct influence upon 
the respiratory system. Yet dyspnea, bronchitis, etc., the result 
of a dropsical condition, are relieved by the administration of the 
drug. 

Absorption and Elimination. — Diuretin is somewhat rapidly ab- 
sorbed, being eliminated mainly by the kidneys, the process greatly 
stimulating the renal epithelium. It is proper to state, however, 
that some authors attribute the diuretic power of the drug to its 
action upon the circulation, rather than to any effect upon the 
secreting structures of the kidney. The author's experience leads 
him to incline to the opinion that the principal action of the drug 
is upon the kidneys. 

In cases where diuretin is indicated the amount of urine is 
increased from three- to sixfold in twenty-four hours, under its 
administration the diuretic action of the drug gradually reaching 
its maximum between the second and third days. In the case of 
healthy persons diuretin has little influence upon the amount of 
urine excreted. 

Untoward Action. — In certain individuals the drug causes great 
disturbance of the gastro-intestinal tract, such as nausea, vomiting, 
diarrhea, palpitation of the heart, headache, and slight fever ; occa- 
sionally cutaneous eruptions may be present. 

Poisoning. — No cases of poisoning are recorded. 

Therapeutics. — The drug is used exclusively as a diuretic in 
cases of dropsy, ascites, pleuritic effusion, etc. 

Diuretin is worthy of a thorough trial for the removal of drop- 
sical fluids, irrespective of the cause. 

Dr. Herrick of Chicago, who has not only devoted much study 



DIURETICS. 679 

to the literature of the subject, but has also had a wide experience 
with the remedy, in a recent paper on " Diuretin " sums up the 
medical uses of the drug as follows : 

" Diuretin is a diuretic acting by direct stimulation of the renal 
epithelium, and best suited to cases in which there is general drop- 
sical effusion. It is the best medicinal remedy for removing drop- 
sical fluid due to valvular disease of the heart after digitalis and 
pure cardiac tonics have failed. Diuretin has oftentimes a bene- 
ficial effect in other circulatory diseases with dropsy, as myocarditis, 
pericarditis, aneurysm, arteriosclerosis. Its action is here more 
uncertain than in valvular disease. In the dropsy of nephritis it 
can be used without danger of irritating the kidney, the effects in 
acute nephritis being more certain than in chronic nephritis. Where 
the renal epithelium has undergone too extensive degeneration the 
drug may fail to act. In the dropsy of portal obstruction, and 
especially of cirrhosis of the liver, it usually fails to give good 
results." 

Contraindications. — There are no special contraindications to 
the use of diuretin, unless it be in cases of marked gastric irritation, 
when the drug would undoubtedly aggravate the symptoms. 

Administration. — Diuretin may be given in capsules or dis- 
solved in some aromatic water or in milk. It should never be 
dispensed in powders, since it absorbs carbonic acid from the air 
and undergoes decomposition. 

It is preferable to give the drug in solution ; and it can be easily 
associated with digitalis and similar remedies, but when used with 
the cardiac remedies the doses of diuretin should be smaller. 

When giving this drug in cases of marked ascites, or for the 
removal of large quantities of dropsical fluid, the first doses should 
be small and gradually increased to the maximum amount or until 
the desired effect be produced, lest by a too sudden removal of the 
fluid alarming collapse ensue. 

As acids are incompatible with the drug, diuretin should not be 
given immediately after meals, but its administration postponed for 
about three hours, to avoid unpleasant symptoms arising from the 
action of the gastric juice upon the remedy. 

The practice of adding fruit syrups or juices to a solution of 
diuretin for the purpose of rendering it more palatable should be 
strictly avoided, since the theobromine is precipitated by the vege- 
table acids as a thick white sediment. 



680 A TEXT-BOOK OF MATERIA MEDICA. 

The maximum daily amount which can be safely administered 
is 150 grains (9.72 Gm.). The average daily amount is 45 to 105 
grains (2.9-7.0 Gm.), given in divided doses of about 15 grains 
(1.0 Gm.) each. 

If diuresis is not increased in six days, the use of the drug 
should be suspended and recourse to other treatment adopted. 

Piperazlnum— Piperazlni— Piperazin. 

(PlPERAZIDINE; ETHYLENEIMINE ; DlETHYLENEDIAMINE ; DlSPERMINE.) 

Origin. — Obtained by the action of Ammonia on Bromide or 
Chloride of Ethylene. 

Description and Properties. — It occurs as a crystalline solid, 
exceedingly soluble in water, the solution being practically taste- 
less. When exposed to the air the drug is very deliquescent, 
becoming completely liquefied on long exposure. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Antagonists and Incompatibles. — The incompatibles are alka- 
loids, tannic acid, preparations of cinchona, salts of iron, alum, 
Donovan's solution, acetanilid, phenacetine, and sodium salicylate. 

Synergists. — Lithium and its salts and the lithontriptics enhance 
the therapeutic action of piperazin. 

Physiological Action and Therapeutics. — The drug apparently 
has no effect whatever upon either the Digestive, Circulatory, or 
Respiratory Systems. Excessive doses, however, have affected the 
Nervous System, producing certain untoward manifestations, such 
as muscular tremors, hallucinations, and clonic spasms. 

The drug is non-irritating when applied to mucous membranes. 

Piperazin is rapidly absorbed from the stomach, circulates in 
the blood unchanged, and reaches the concretions of urates and 
gouty deposits, neutralizing and dissolving them, thus hastening 
their removal from the body. Piperazin may be detected in the 
urine two hours after ingestion. 

The only important action of piperazin is its property of dis- 
solving uric acid, with which it forms a neutral and exceedingly 
soluble salt, piperazin urate, said to be seven times more soluble in 
water than lithium urate. 

The superiority of piperazin over lithium carbonate as a uric- 
acid solvent has been indubitably established. 

Under the administration of piperazin there is an enormous in- 
crease in the amount of urea, with a corresponding decrease in the 
elimination of uric acid, indicating that there is active oxidation. 



DIURETICS. 68 1 

While greatly increasing the amount of urea eliminated, neither 
the volume of urine nor the acid reaction of that fluid is ordinarily 
influenced. Moreover, while in certain cases diuresis is consider- 
ably augmented, the specific gravity of the urine is lowered, al- 
though the urine never becomes alkaline or even neutral. 

Therapeutics. — Externally and Locally. — A solution of pipera- 
zin (i to 2 per cent.) in a mixture of water and alcohol (i to 4, re- 
spectively) has been applied locally to gouty joints and swellings 
with doubtful results. A similar solution is slightly effective in 
relieving the pain, allaying the inflammation, and hastening the 
healing of gouty sores. 

Solutions of piperazin may be injected into the bladder in order 
to dissolve vesical calculi. 

The drug has been recommended for local hypodermic injection 
in gout, although Wittsock, who used it in this manner consider- 
ably, claims that the subcutaneous administration of piperazin is 
painful and dangerous, causing inflammation with tendency to 
abscess. 

In the treatment of gout some observers have reported good 
results. For renal and vesical calculi of the urates it is doubtful if 
this drug is of much service, yet it is worthy of extended trial. It is 
of service in chronic cystitis and in some forms of arthritis. The 
pruritus of diabetes is often benefited by it. 

Contraindications. — None of importance can be named. 

Administration. — Piperazin is best given in' aerated water, al- 
though it may be acceptably administered in distilled water and 
syrup, orange flower water, or other agreeable vehicle. 

Saccharlnum— Saccharlni— Saccharin. 

(Anhydro-ortho-sulphamin-benzoic Acid; Benzoyl-sulphonic-imide; Gluside; 

Glucusimide.) 

Origin. — A derivative of the aromatic series, prepared by a 
complicated process from Toluene. 

Description and Properties. — A white, crystalline powder, of 
an acid reaction, a faint, amygdaloid odor, and an intensely sweet 
taste. One part of saccharin in 70,000 parts of water will impart 
to the solution a decidedly saccharine flavor, the drug being nearly 
300 times sweeter than cane-sugar. 

Saccharin is slightly soluble in water, 1 : 400 ; soluble in 30 
parts of alcohol ; and freely soluble in glycerin. The commercial 
article is usually very impure. 



682 A TEXT-BOOK OF MA TERIA MEDICA. 

Dose. — J-2 grains (0.03-0.12 Gm.). 

Physiological Action. — In a neutral or alkaline medium sac- 
charin acts as an antiseptic. Internally it exerts no notable influ- 
ence. It is said that when mixed with food it interferes with the 
action of saliva upon starch, and it is thought to retard the action 
of the other digestive ferments. The drug is not decomposed in 
the body, and is eliminated by the kidneys unchanged, increasing 
the amount of chlorides excreted in the urine, which fluid is so 
influenced by the drug that it does not so readily undergo fer- 
mentation. 

Therapeutics. — Externally and Locally. — Saccharin is used as 
a mouth-wash, being especially beneficial in aphtha. Felici of 
Rome highly recommends the application of a solution of saccharin 
in ozena. 

Internally. — The principal use of the drug is as a substitute for 
sugar in cases of diabetes. 

Dr. James Little recommends saccharin in chronic cystitis with 
ammoniacal urine. 

The drug is extensively used in various elixirs, syrups, etc. to 
overcome the bitterness of quinine and other bitter alkaloids. 

Administration. — Saccharin should be given in solution, or in 
tablets which may be dissolved singly in a cup of coffee. 

Peabody recommends the following formulae : 

R. Saccharine, 10.0; 

Sodium carbonate, Ii.o; 

Aquae, q. s. 100.0. 

Dose for tea, coffee, etc., to be determined by experiment. 

&. Saccharine, 45 grains; 

Sodium carbonate, 30 grains ; 

Mannite, 10 ounces. 

Divide in 100 equal parts and use as lump sugar for sweetening purposes. 



CATHARTICS. 683 

GROUP XIV.— CATHARTICS. 
Cathartics or Purgatives are substances which cause hurried 
evacuation of the bowels either by direct local irritation of the 
intestinal mucous membrane or by setting up an osmotic current 
from the tissues toward the lumen of the intestines, causing an 
accumulation of fluid in the bowels — in both cases causing in- 
creased peristalsis and watery or semisolid evacuations. 

Mechanism of Purgation. — It should be remembered that the 
epithelial surfaces through which the substances needful to the 
body enter it, and the waste-products leave it, are physiologically 
outside the body. The mucous membrane of the alimentary canal 
is in a sense as much external as the skin covering the surface of 
the body and is subject to the same irritating influences. The 
muscular mechanism of the intestines is somewhat peculiar in that 
it possesses the power to rhythmically contract and relax in a 
wave-like manner (peristalsis), the peristaltic waves travelling down- 
ward. These rhythmical movements of the intestines carry their 
contents along their lumen from the cardia to the rectum, and are 
to a large extent independent of the central nervous system, 
although in a way controlled by a nervous mechanism. The nor- 
mal contents of the small intestine are fluid, and are passed into 
the large intestine as such. In their passage along the large 
bowel the fluid part is largely absorbed and the semisolid part 
remaining is passed on into the rectum as feces. 

In order that any substance may act as a purgative it must 
change the normal contents of the bowels in such a way as to 
cause fluid or semisolid evacuations. When a substance locally 
irritates the intestinal mucous membrane the intestines respond by 
increased peristalsis, which hurries the fluid contents of the small 
intestine through the large bowel so rapidly that absorption does 
not take place and the feces are evacuated in a fluid form. 

While increased peristalsis may be caused by action on the 
nervous mechanism of the intestines the exact modus operandi 
is imperfectly understood, and until the action of drugs on 
such mechanism is more thoroughly investigated we must as- 
sume that the action of purgatives is due chiefly to their local 
influence. 

Cathartics may be classified according to their various actions, 
the following table serving to show how and where the various 
drugs exert their several influences : 



684 



A TEXT-BOOK OF MA TERIA MEDIC A. 



i. Classification according to their Mode of Action. 



Laxatives. 
Cassia. 
Castor oil. 
Cascara sagrada. 

* Glycerin. 

* Magnesia. 

* Magnesium carbonate. 
Manna. 

Sulphur. 
Taraxacum. 

There are certain drugs 
which are not classed as 
cathartics, which are some- 
times prescribed by physi- 
cians as laxatives, such as — 
Belladonna.* 
Ergot* 
Hyoscyamus.* 
Nux vomica.* 
Physostigma.* 
Stramonium.* 

Certain articles of diet are 
laxative, such as bran bis- 
cuit, brown bread, ginger- 
bread, oatmeal, figs, honey, 
molasses, prunes, raspber- 
ries, strawberries, tama- 
rinds, olive oil, etc. 



Simple purgatives. 
Aloes. 
Calomel.* 
Cascara sagrada 

(full doses). 
Castor oil (full 

doses). 
Ox-gall. 
Rhubarb. 
Euonymus. 
Iris. 

Juglans. 
Leptandra. 
Senna. 



Hydragogue purgatives. 
Croton oil (small 

doses). 
Elaterin. 
Gamboge. 

Salines. 
Magnesium citrate. 
Magnesium sulphate. 
Potassium bitartrate.* 
Potassium sulphate. 
Potassium tartrate.* 
Potassium and sodium 

tartrate. 
Sodium phosphate. 
Sodium sulphate. 



Drastic purgatives. 
Cathartic acid (hy- 

podermically). 
Colocynth. 
Croton oil. 
Elaterin. 
Gamboge. 
Jalap. 
Scammony. 
Podophyllin 



2. Classification according to their Manner of reaching the Intestinal 

Mechanism. 



By first contact. 
Nearly all the drugs used as cathartics. 



By circulation contact. By excretion contact. 



Morphine.* 

Muscarine.* 

Physostigma.* 

Pilocarpine.* 

Strychnine.* 



Aloes. 
Castor oil. 
Croton oil. 
Colocynth. 
Elaterium. 
Podophyllin. 
Rhubarb. 
Senna. 



j. Conditions of the Intestines affecting the Action of Drugs. 



Drugs requiring the presence of 
an alkali or bile to act. 

Aloes. 
Elaterium. 
Gamboge. 
Jalap. 



Drugs requiring the presence 
of an acid to act. 

Magnesium carbonate.* 
Magnesia* 



Drugs not requiring the presence 
of either alkali, bile, or acid. 

Castor oil. 
Colocynth. 
Croton oil. 
Euonymin. 



(Drugs marked with an asterisk (*) are here given in detail ; others are described 
elsewhere.) 



CATHARTICS. 



685 



Drugs requiring the presence of 
an alkali or bile to act. 

Scammony. 
Sulphur. 



Drugs not requiring the presence 
of either alkali, bile, or acid. 

Iris. 

Leptandra. 
Magnesium citrate. 
Magnesium sulphate. 
Podophyllin. 

Potassium and sodium tar- 
trate. 
Rhubarb. 
Senna. 
Sodium phosphate. 



4.. Classification according to the Anatomical Portion of the Intestinal, 
Canal on which they Act. 



Small intestine 


Colon. 


Descending colon and rectum. 


Calomel.* 


Colocynth. 


Aloes. 


Castor oil. 


Elaterium. 




Jalap. 


Gamboge. 




Leptandra. 


Magnesium citrate. 




Podophyllin. 


Magnesium sulphate. 




Rhubarb. 


Potassium bitartrate.* 




Scammony. 


Potassium sulphate. 




Senna. 


Potassium tartrate.* 
Potassium and sodium tartrate. 
Sodium sulphate. 




5. Classification of Cathartics according to 


Other Actions. 


Stomachics. 


Hepatic stimulants and Galactagogues . 
cholagogues 


Rendering the Increasing 
milk menstrual 
purgative. flow. 


Aloes. 


Aloes. Castor oil. 


Aloes. Aloes. 


Cascara sagrada. 


Colocynth. 


Castor oil. 


Euonymin. 


Colchicin. 


Rhubarb. 


Leptandrin. 


Euonymin. 


Senna. 


Iridin. 


Iridin. 


There are 


Rhubarb. 


Leptandrin. 


probably some 
other cathartics 




Podophyllin. 


that affect the 




Sodium phosphate. 


milk. 




Sodium sulphate. 






Cholagogues. 






Aloes. Mercury with chalk* 






Calomel.* Pil. hydrargyri.* 






Colocynth. Podophyllin. 






Euonymin. Rhubarb. 






Iridin. 





(Drugs marked with an asterisk (*) are here given in detail; others are described 
elsewhere. ) 



686 A TEXT-BOOK OF MATERIA MEDICA.- 

Intestinal peristalsis is increased probably by the stimulation 
of— 

1. The intestinal muscles (moderate stimulation); 

2. The afferent nerves connecting the intestinal mucous mem- 

brane with Auerbach's ganglia ; 

3. Auerbach's ganglia; 

4. The ends of the efferent nerves passing from Auerbach's 

ganglia to the intestinal muscles ; 

5. The ends of the afferent nerves passing from the intestinal 

mucous membrane to the brain ; 

6. The motor centers in the brain ; 

7. The ends of the motor nerves terminating in Auerbach's 

ganglia. 
Depression of — 

8. The inhibitory motor center ; 

9. The ends of the inhibitory motor nerves terminating in 

Auerbach's ganglia; 
10. The inhibitory motor center in the suprarenal plexus. 
It will be seen that any substance which stimulates the motor 
apparatus or depresses the inhibitory motor mechanism will increase 
peristalsis. 

Intestinal secretion may doubtless be promoted by any sub- 
stance which serves to stimulate the secretory or the vaso-dilator 
apparatus, or to depress the inhibitory secretory or vaso-constrictor 
mechanism. 

The methods by which absorption is diminished are not thor- 
oughly understood, but it is known that — 

I. By increasing peristalsis and hastening the removal of fluid 
from the bowels absorption takes place less rapidly ; 

2. By giving drugs — e. g. magnesium sulphate — having high 

osmotic equivalents, with a great affinity for water, the 
absorption of fluid is prevented ; 

3. Substances which in some manner affect the columnar 

epithelium of the intestinal glands retard absorption ; 

4. Drugs which diminish the circulation in the intestinal 

mucous membranes act as deterrents to the absorptive 
process. 
It is apparent that certain drugs produce various effects, and 
that their mode of action varies according to the size of the dose 
and occasionally with the idiosyncrasy of the patient. 

Nearly all cathartic drugs act by some local influence upon the 



CATHARTICS. 687 

intestinal mucous membranes previous to absorption ; others, again, 
affect the bowels after they have entered the circulation — strych- 
nine, for example, physostigmine, pilocarpine, etc., acting in this 
manner. 

Certain other drugs, such as podophyllin, colocynth, etc., if in- 
jected into the circulation are excreted by the mucous membrane 
of the intestines, and by their irritation produce catharsis. 

The condition of the intestinal canal has much to do with the 
activity of certain drugs. Thus certain medicines produce cathar- 
sis regardless of the reaction of intestinal fluids ; others are inert 
without the presence of bile or other alkaline fluids or salts ; and 
still a third class occasion catharsis only when after ingestion they 
come in contact with an acid. Of the last mentioned, magnesium 
carbonate is an excellent example, the drug being inert unless it be 
acted upon by an acid in the stomach or bowels. 

It is a remarkable fact that, as is shown in the tables, different 
cathartics act more energetically upon different portions of the in- 
testines. The action of calomel, for instance, is almost entirely 
confined to the duodenum, while aloes acts only upon the descend- 
ing colon and the rectum. 

In selecting a cathartic, therefore, a knowledge of the part of the 
intestinal canal to be acted upon and the locality in which the drug 
operates is necessary in order to secure the most satisfactory results. 

Many cathartics contain principles which render them tonic to 
the stomach ; others greatly stimulate the secretion of bile (hepatic 
stimulants) ; while the cholagogues merely hasten the expulsion of 
bile from the intestinal canal, preventing its absorption. 

Certain drugs, being excreted in the milk, which it renders 
purgative, are well adapted for administration to the nursing mother 
in order to produce catharsis in the infant. Castor oil, greatly 
augmenting the secretion of milk, is an excellent medium as a 
laxative in such cases. 

Aloes increases the menstrual flow ; other drugs promote the 
secretion of urine, etc. 

Therapeutics. — Cathartics are employed — 

1. To remove feces and produce a simple evacuation of the bowels. 
The Laxatives are best adapted for this purpose. 

2. For the relief of chronic constipation: For this purpose great 
judgment is requisite in the selection of a drug or combination of 
agents, it being important to determine whether there is diminished 
peristalsis or secretion ; whether there exists an atonic condition of 



688 A TEXT-BOOK OF MATERIA MEDICA. 

the intestinal muscles ; or whether the disorder is located in the 
small intestine, the colon, or the rectum. 

3. To remove from the bowels noxious substances or pathogenic 
matter. For this purpose the mercurial preparations, calomel or 
gray powder, are best, since they are not only active cathartics, but 
bactericides as well. 

4. To stimulate the torpid liver. For this purpose the hepatic 
stimulants would naturally be employed. 

5. To lessen the activity of the liver, as in bilious conditions. In 
such cases the cholagogue cathartics should be used. 

6. To deplete the gastro-duodenal mucous membrane, where the 
congested and swollen mucous membrane obstructs the outflow of 
bile, resulting in jaundice. In this condition the salines, especially 
the sodium salts, are the most efficient cathartics. 

7. To promote absorption and remove dropsical effusions in cer- 
tain diseases of the heart, liver, and kidneys. Here active cathar- 
sis is necessary, the hydragogue cathartics being indicated. 

8. To remove urea, etc., from the blood. Occasionally in certain 
renal diseases the functional activity of the kidneys is so defective 
that waste matter, urea, etc., rapidly accumulates in the system, 
occasioning uremic convulsions, coma, or other serious symptoms. 
In such cases it may be necessary to give a drastic purgative, such 
as croton oil, which acts rapidly, causing profuse watery stools. 

. 9. To lower the blood-pressure where high arterial tension aggra- 
vates a malady, as at the onset of many acute diseases, and in 
cerebral hemorrhage, meningitis, etc. In these conditions it is 
necessary to employ such drugs as, by dilating the intestinal blood- 
vessels, drain the blood away from other organs and cause abun- 
dant watery discharges from the bowels. Hydragogue or drastic 
purgatives answer the required purpose. 

10. For the relief of hemorrhoids ,'m which cases the mild laxa- 
tives, such as sulphur, senna, etc., are serviceable. 

11. To aid the restoration of the catamenia. For this purpose 
aloes is usually employed, particularly if it be necessary to deter- 
mine more blood to the pelvic organs. If depletion be required, 
the selection should be made from the hydragogue cathartics. 

12. To purge the nursing infant through the mother's milk. For 
this purpose such drugs as rhubarb, senna, and castor oil may be 
administered to the mother. 

13. To lower the temperature in fever, in which cases the saline 
cathartics may be advantageously employed. 



CA THA R TICS. 689 

Contraindications. — Active catharsis by the more powerful 
hydragogue or drastic purgatives would be contraindicated in ap- 
pendicitis, peritonitis, typhlitis, intussusception, pregnancy, and 
typhoid fever, or where there is inflammation of the mucous mem- 
brane of the gastro-intestinal tract 

Administration. — Probably no group of medicines demands 
greater judgment in administration than Cathartics. 

Ordinarily, the efficiency of these agents is increased and their 
operation rendered less irritant by associating drugs acting upon 
different portions of the alimentary canal. Their action, too, is 
more prompt and certain when the remedies are given upon an 
empty stomach and the efficiency of their operation is enhanced 
by exercise and diminished by sleep. 

The action of cathartics is promoted by the addition of small 
doses of emetics, mydriatics, quinine, and bitters, quinine especially 
strengthening the action of magnesium sulphate. Mild diluent 
beverages also promote the activity of cathartics. Cold applied 
to the abdomen, enemata, massage of the abdominal walls, and 
electricity, all act as adjuvant measures in the employment of 
purgative medicines. 

As has been previously suggested, a knowledge of the portion 
of the intestinal canal upon which the various cathartics act is of 
primary importance. Thus, if it be necessary to influence only 
the duodenum, calomel or podophyllin should be used ; if the 
small intestine, senna or jalap ; if the descending colon or rectum, 
aloes, — the drugs acting upon these organs alone. 

Moreover, due consideration should be given to the proper time 
for the administration of the different cathartics, the resinoid pur- 
gatives acting best when taken at night or before dinner, and the 
salines when taken in the morning before breakfast. 

The mode of administration is also of great importance, in 
order to obtain from these agents the fullest benefit. The salines, 
for instance, act best when given in solution in either very cold or 
very hot water, their activity being enhanced by association with 
bitters, iron, or sulphuric acid. On the other hand, the resinoid 
drugs should be administered in the form of pills, and if, for any 
reason, it is desirable that the drug should enter the intestine with- 
out coming in contact with the mucous membrane of the stomach, 
the drug may be given in the form of pills coated with keratin, 
which is unaffected by the gastric juice, but readily dissolved in 
the alkaline intestinal juices. 

44 



690 A TEXT-BOOK OF MA TERIA MEDICA. 

In the following detailed description cathartic drugs are grouped 
according to their modus operandi, the mildest drugs or laxatives 
being first considered. 

LAXATIVES. 

Certain substances never produce active purgation, but simply 
unload the bowels by slightly increasing both peristalsis and secre- 
tion, expelling the feces in a softened though solid and formed 
condition, without irritation and without perceptibly affecting the 
general system. 

These agents are especially useful where we wish to evacuate 
the bowels with the least possible local derangement, as in simple 
constipation from dyspepsia, in children, pregnant women, con- 
valescents from acute disease, or patients affected with hemorrhoids, 
hernia, affections of the rectum or womb, typhoid fever, early 
simple diarrhea, or in inflammation or surgical operations about 
the abdomen and pelvis. 

Besides the laxative drugs mentioned below there are many 
articles of diet which by purely mechanical action produce 
catharsis, such as oatmeal, brown bread, whole flour, molasses, 
prunes, figs, onions, spinach, celery, lettuce, etc. 

Cassia Fistula— Cassiae Fistulae— Cassia Fistula. 

zr. s. i>. 

(Purging Cassia.) 

Origin. — The fruit of Cassia Fistula L., a tree 30 to 50 feet 
(9-15 M.) high, indigenous in the East Indies. 

Description and Properties. — Cylindrical, ij to 2 feet (45-60 
Cm.) long, nearly I inch (25 Mm.) in diameter, blackish-brown, 
somewhat veined, the sutures smooth, forming two longitudinal 
bands ; indehiscent, internally divided transversely into numerous 
cells, each containing a reddish-brown, glossy, flattish-ovate seed 
imbedded in a blackish-brown sweet pulp ; odor resembling that 
of prunes. 

Dose. — 1-2 drachms (4.0-8.0 Gm.). 

Official Preparation. 

Conffcctio Sfcnnae — Confectionis Sennae — Confection of Senna. — Described 
under Senna, p. 707. 

Physiological Action and Therapeutics. — Cassia is a mild and 
pleasant laxative. It is seldom given alone, however, but forms an 
ingredient in the confection of senna. 



CATHARTICS. 691 

Oleum Ricini— Olei Riclni— Castor Oil. U. S. J\ 

Origin. — A fixed oil expressed from the seed of Ricinus com- 
munis L., a plant indigenous in Southern Asia and cultivated in 
temperate countries for ornament and other purposes, remaining 
a large annual. 

Description and Properties. — A pale-yellowish or almost color- 
less, transparent, viscid liquid, having a faint, mild odor and a 
bland, afterward slightly acrid and generally offensive taste. Solu- 
ble in an equal volume of alcohol and in all proportions in abso- 
lute alcohol. Castor oil should be kept in well-stoppered bottles. 

Dose. — J— 2 fluidounces (8.0-60. Cc.) 

Physiological Action. — Externally and Locally. — Castor oil — 
like other bland fixed oils, such as almond oil, olive oil, etc. — is 
sedative and protective when applied to the skin or mucous 
membranes. 

Internally. — The only important action is upon the intestinal 
tract, on which the oil acts as a mild irritant, causing purgation. 
Chemically castor oil is a combination of glycerin, fatty acids, and 
ricinoleic acid. This combination passes the stomach unchanged, 
but in the presence of the bile and pancreatic juice it is broken up 
into glycerin and ricinoleic acid; the ricinoleic acid combines with 
sodium and forms sodium ricinoleate, which has marked irritating 
properties. The ricinoleate of sodium is absorbed and excreted in 
various ways, appearing in the mother's milk and imparting to it 
purgative properties. 

Castor oil requires from four to six hours to operate, its action 
being usually attended with little pain. Indeed, the author is 
inclined to attribute anodyne properties to the drug, since it has 
frequently occurred to him in practice that a dose of castor oil 
given to a child suffering with colicky pains, while producing no 
movement of the bowels, served to allay the distress and cause 
the patient to sink into a quiet sleep. 

The poisonous principle, ricin, found in castor beans is an albu- 
minous substance belonging to the globulin group, and is generally 
termed a toxglobulin. Ricin is one of the most powerful poisons 
known, but being insoluble in oil and soluble in water it is not 
present in expressed castor oil. The symptoms of poisoning from 
castor beans are violent abdominal pain, vomiting, purging, and 
collapse. Post-mortem examinations have revealed evidences of 
severe inflammation in the stomach and intestines. 



692 A TEXT-BOOK OF MATERIA MEDICA. 

Castor oil should not be used as an habitual laxative, its con- 
tinual employment being liable to occasion constipation with all 
its attendant evils. 

Therapeutics. — Castor oil is used alone or associated with bal- 
sam of Peru as a sedative protectant dressing for superficial ulcera- 
tions. The drug is also serviceable in various diseases of the skin 
and mouth. 

It is probably superior to all other laxatives, and is applicable 
to all conditions for which laxatives are employed. In large doses 
it is one of the best purgatives to give in conjunction with an 
anthelmintic. 

Administration. — The unpleasant taste of castor oil is the only 
objection to its use. Yet it can be rendered quite palatable by 
mixing it with an equal quantity of glycerin, to which may be 
added a few drops of oil of cinnamon or oil of wintergreen. 

Various other devices for disguising the taste have been adopted, 
such as enveloping the oil in the froth of beer, ale, or porter, or 
washing out the mouth with brandy or whiskey previous to admin- 
istration, and allowing the patient to swallow the oil quickly, when 
it will not adhere to the mouth and fauces, especially if followed 
by a drink of some alcoholic liquid. 

In the form of an emulsion the taste of the oil is well disguised. 
There are also soft capsules of castor oil which are of course taste- 
less, yet they are too bulky to be popular. 

Castor-oil emulsion may be used as an enema when a mild 
injection is required. 

Rhamnus Purshiana— Rh&mni Purshianae— Cas- 
cara Sagrada. U. S. I>. 

Origin. — The bark of Rhamnus Purshiana D. C, a shrub or 
small tree 15 to 20 feet (4.5-6 M.) high, indigenous on the Pacific 
coast of North America from the British possessions southward to 
Northern California. 

Description and Properties. — Quills or curved pieces about 
\ to 4 inches (3-10 Cm.) long and about -^ inch (2 Mm.) thick; 
outer surface brownish-gray and whitish, the young bark with 
numerous, rather broad, pale-colored warts ; inner surface yellow- 
ish to light brownish, becoming dark brown with age ; smooth or 
finely striate, fracture short, yellowish, in the inner layer of thick 
bark somewhat fibrous ; inodorous ; taste bitter. 

The bark contains red, yellow, and brown resins, tannic, malic, 



CATHARTICS. 693 

and oxalic acids, a volatile oil, and a glycoside, xantho-rhamnin or 
purshianin. 

Dose. — 30-60 grains (2.0-4.0 Gm.). 

Official Preparation. 
Extractum Rhamni Purshianae Fluidum — Extracti Rhamni Purshianae 
Fluidi — Fluid Extract of Rhamnus Purshiana. — Dose, %-i fluidrachm (1.0-4.0 

Cc). 

Unofficial Preparations. 

Certain pharmaceutical chemists, in order to overcome the bitter taste of cascara 
have devised various preparations, such as — 
Cascara Cordial. 

Aromatic Fluid Extract of Cascara. 
Elixir of Cascara, etc. 

Physiological Action. — Cascara sagrada is a peculiarly efficient 
laxative, although in certain individuals it appears to be inert unless 
associated with other purgatives. The bitter principle it contains 
gives to the drug stomachic properties, and it is also said to stimu- 
late slightly the functional activity of the liver. 

The action of cascara is seldom attended with irritation or un- 
pleasant symptoms, the drug requiring from six to ten hours to 
operate. 

Therapeutics. — Cascara is a very valuable laxative, being em- 
ployed chiefly to overcome habitual constipation due to simple tor- 
por of the colon without associated disease. The drug is not 
adapted for rapid evacuation of the bowels, but rather for regulating 
their action. 

Administration. — The fluid and solid extracts are usually em- 
ployed, although the cascara cordial and the aromatic fluid 
extract, while requiring larger doses, are so palatable that they 
have become deservedly popular. 

Whatever be the preparation used in cases of habitual consti- 
pation, it should be given in small but repeated doses, gradually 
diminished until a natural action of the bowels shall have been 
established. The drug should be administered upon an empty 
stomach and in as diluted a condition as possible. 



Magnesia— Magnesiae— Magnesia. TJ. S. P. 

(Light Magnesia; Calcined Magnesia.) 
Origin, description, and properties given under " Alkalies," p. 169. 
Dose. — 5-60 grains (0.32-4.0 Gm.). 



694 A TEXT-BOOK OF MATERIA MEDIC A. 

Magnesii Carbonas— Magnesii Carbonatis— Mag- 
nesium Carbonate. U. 8. i*. 

Origin, description, and properties given under " Alkalies," p. 
169. 

Dose. — ^—2 drachms (1.0-8.0 Gm.). 

Physiological Action. — Both magnesia and magnesium car- 
bonate are mild antacid laxatives, requiring the presence of an 
acid in the stomach and bowels to render them active. Occasion- 
ally, when there is marked acidity of the stomach, magnesium 
carbonate occasions flatulence. 

When taken in large amounts or for a long time magnesia tends 
to accumulate in the intestines. This untoward effect may be pre- 
vented by administering with the drug lemonade, the acid of which 
increases the solubility of the magnesia. 

Therapeutics. — Magnesium carbonate as a protective powder 
is an effective agent in the treatment of dermatitis of the external 
auditory passage. The drug is a valuable antidote to counteract 
the effects of phosphorus-poisoning in the throat. 

Both magnesia and magnesium carbonate are mild alkalies, 
and may be used for the same purposes as the alkalies. They are 
serviceable antidotes to poisoning from mineral and oxalic acids 
and many mineral salts. They are pleasant laxatives, being ex- 
tensively employed for children. 

Manna— Mannae— Manna. U. 8. J\ 

Origin. — The concrete, saccharine exudation of Fraxinus Ornus 
L., a slender tree indigenous on the northern shore of the Mediter- 
ranean from Asia Minor west to Spain. 

Description and Properties. — Flattish, somewhat three-edged 
pieces, about 8 inches (20 Cm.) long and 2 inches (5 Cm.) broad 
(usually smaller), friable, externally yellowish-white, internally 
white, porous, and crystalline ; or fragments of different sizes, 
brownish-white and somewhat glutinous on the surface, internally 
white and crystalline ; odor honey-like ; taste sweet, slightly bitter, 
and faintly acrid. Manna contains a resin, the purgative principle, 
besides mannite, fraxin, and sugar. 

Dose. — J— i ounce (16.0-32.0 Gm.), dissolved in hot water. 

Official Preparation. 

Infusum SSnnse Comp6situm — Infusi SSnnae Compftsiti — Compound Infu- 
sion of Senna. — See Senna, p. 707. 



CATHARTICS. 695 

Physiological Action and Therapeutics. — Manna is a laxative, 
cholagogue, and nutrient. Its mild laxative action renders the 
drug peculiarly efficient in constipated conditions of pregnant 
women, and children and persons suffering from piles or irritation 
of the genito-urinary tract. 

The drug is slow in its action, tending to confine the bowels 
after the primary laxative effect. 

Sulphur Sublimatum— Sulphuris Sublimati— Sub- 
limed Sulphur. U. 8. JP. 

Origin. — Obtained from Crude Sulphur by sublimation. 

Description and Properties. — A fine yellow powder, having a 
slight characteristic odor and a faintly acid taste. Insoluble in 
water ; slightly soluble in absolute alcohol ; more readily soluble 
in benzin, benzol, oil of turpentine and many other oils, as well as 
in ether, chloroform, and boiling aqueous solutions of alkaline 
hydrates. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Official Preparations. 

Stilphur Lotum — Stllphuris Loti — Washed Sulphur. — Origin. — Sublimed Sul- 
phur, 100; Water, 100; Ammonia Water, 10; digested, filtered, drained, and dried. 

Description and Properties. — A fine yellow powder without odor or taste. Insoluble 
in water, but soluble in the substances which dissolve sulphur. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

UnguSntum Stllphuris— UnguSnti Sulphuris— Sulphur Ointment.— Washed 
Sulphur, 300; Benzoinated Lard, 700. For external use. 

Washed sulphur is an ingredient of compound liquorice powder. 

Sulphur Praecipitatum— Sulphuris Praecipitati— 
Precipitated Sulphur. U. S. P. 

(Milk of Sulphur; Lac Sulphur.) 

Origin. — Sublimed Sulphur is boiled with Slaked Lime and 
Water. To the solution is added Hydrochloric Acid, which throws 
down Sulphur as a fine precipitate, the powder being washed and 
dried. 

Description and Properties. — A fine amorphous powder of a 
pale-yellow color, without odor or taste. Insoluble in water. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Physiological Action. — Externally and Locally. — Sulphur is an 
active parasiticide, antiseptic, and keratoplastic agent. Upon the 
skin the drug of itself has no influence ; a portion of it, however, 



696 A TEXT-BOOK OF MA TERIA MEDICA. 

is converted into hydrogen sulphide, which acts as a mild cutane- 
ous irritant. 

Internally. — As observed, sulphur proper has no action either 
externally or locally, although it is a normal constituent of nearly 
all the solids and fluids of the body. When ingested some of it 
is converted into hydrogen sulphide and other sulphides, which 
increase the intestinal secretions and promote peristalsis. 

The drug is chiefly excreted with the stools, which are rendered 
soft and semi-liquid. A portion of the hydrogen sulphide formed 
is eliminated through the kidneys, lungs, skin, and milk-glands. 
The drug is usually found in the urine as sulphate. 

There is imparted to the breath the offensive odor of hydrogen 
sulphide, and the minute portion eliminated through the skin is suf- 
ficient to discolor silver ornaments in contact with the body-surface. 

While hydrogen sulphide is a powerful poison, decomposing 
the blood and paralyzing the nervous and muscular systems, the 
amount formed and absorbed under the administration of sulphur 
is too small to produce marked toxic symptoms, even when large 
amounts of sulphur have been ingested, there is produced only 
violent vomiting and purging, a slight elevation of temperature, 
and a distinct odor of hydrogen sulphide in the breath. 

When sulphur is used in full doses for a long time, it tends to 
impair the quality of the blood and produce muscular weakness. 
Occasionally untoward manifestations, such as miliary eruption and 
eczema, accompany either the external application or the ingestion 
of the drug. 

As a laxative sulphur is slow and mild, although it occasionally 
causes considerable flatus, in some cases rendering the drug objec- 
tionable as a purgative. 

Therapeutics. — Externally and Locally. — While classed among 
laxative drugs, sulphur is a most efficient remedy in many diseases 
of the skin, nose, throat, etc., the external uses of sulphur being 
very numerous. 

The drug is perhaps the most serviceable parasiticide we possess 
in scabies, sulphur ointment well rubbed into the skin being usually 
sufficient to destroy the parasite. 

Even diseases induced by vegetable parasites, such as tinea 
versicolor, etc., are cured by inunctions of sulphur ointment. 

The drug is successfully employed in the treatment of infil- 
trated eczema, impetigo, sycosis, ecthyma, acne, comedo, and psoriasis. 

The flowers of sulphur is an old domestic remedy, and quite 



CATHARTICS. 697 

an efficient one, in diphtheria and pharyngitis. Finally, Coroden 
and Duchane have both reported the successful treatment of 
sciatica by enveloping the affected limb in precipitated sulphur, 
the profuse sweating induced being followed by a decided allevi- 
ation of pain. 

When sulphur is burned in moist air sulphur dioxide is formed, 
which, if large quantities are confined in a small space and added 
to moist steam, is a fair disinfectant. It is probable that the 
old-fashioned methods of sulphur fumigation are little short of 
farcical. 

Internally. — The principal internal use of sulphur is as a mild 
laxative, the drug being especially indicated for persons afflicted 
with hemorrhoids or anal fissure. 

Lozenges are prepared containing sulphur and cream of tartar, 
which, if taken daily for some time, will overcome habitual consti- 
pation, being especially serviceable in constipation due to disease 
of the liver. 

Sulphur has been used internally, and occasionally with con- 
siderable success, in bronchitis, chronic rheumatism, and eczema 
attended with much itching. 

Administration. — Sulphur may be given in the form of loz- 
enges or mixed with molasses — either alone or associated with cream 
of tartar, which is said to enhance the action of sulphur. Milk 
and syrup have been used as vehicles in the administration of the 
drug. 

Sulphurous baths, both natural and artificial, have been em- 
ployed in the treatment of rheumatism, gout, and some cutaneous 
affections. Not only for these purposes, but for their laxative 
influence as well, sulphurous waters are held in great repute. 

Taraxacum— Taraxaci— Taraxacum. U. S. P. 

(Dandelion.) 

Origin. — The root of Taraxacum officinale Weber, a perennial, 
acaulescent herb found in most countries of the northern hemi- 
sphere. 

Description and Properties. — Slightly conical, about 1 2 inches 
(30 Cm.) long and \ to 1 inch (12-25 Mm.) thick above, crowned 
with several short, thickish heads, somewhat branched, dark brown, 
longitudinally wrinkled; when dry breaking with a short fracture, 
showing a yellowish, porous central axis surrounded by a thick, 



698 A TEXT-BOOK OF MATERIA MEDIC A. 

white bark containing numerous milk-vessels arranged in con- 
centric circles ; inodorous ; bitter. 

The drug contains a bitter principle, taraxacin, besides inulin y 
resin, sugar, and mucilaginous substances. 

Dose. — 1-4 drachms (4.0-15.0 Gm.). 

Official Preparations. 

Extractum Tar^xaci — Extr&cti Taraxaci— Extract of Taraxacum. — Dose, 
5-60 grains (0.3-4.0 Gm.). 

Extractum Taraxaci Fluidum — Extracti Taraxaci Fluidi — Fluid Extract 
of Taraxacum. — Dose, 1-4 fluidrachms (4.0-15.0 Cc). 

Physiological Action and Therapeutics. — Taraxacum is a 
stomachic tonic, diuretic, laxative, cholagogue, and feeble hepatic 
stimulant. It has been a popular remedy for constipation associated 
with hepatic congestion and atonic dyspepsia, yet the drug is now less 
employed than formerly, in actual practice being usually united 
with other laxatives. 

The extract or fluid extract may be given, the latter and the 
expressed juice being the more active. 

SIMPLE PURGATIVES. 

These differ from laxatives only in degree, the former being 
more active, exciting greater peristaltic action and causing a larger 
secretion from the intestinal glands. Simple purgatives usually oc- 
casion one or more copious and somewhat liquid stools, frequently 
accompanied by considerable irritation and griping. 

Aloe— Aloes— Aloes. U. S. I*. 

Origin. — The inspissated juice of the leaves of Aloe (A. vera 
(L.) Webb; A. Perryi Baker), a plant resembling the so-called 
century plant {Agave Americana), indigenous in India and North- 
eastern Africa, and naturalized along the shores of the Mediter- 
ranean and in the West Indies. 

Official Varieties. 

Aloe Barbad&nsis — Aloes Barbadensis — Barbadoes Aloes (Curacoa 
Aloes). — Origin. — Prepared from Aloe vera. 

Habitat. — Island of Barbadoes. 

Description and Properties. — Hard masses, orange-brown, opaque, translucent on 
the edges; fracture waxy or resinous, somewhat conchoidal; odor saffron-like; taste 
strongly bitter. 



CATHARTICS. 699 

Dose. — 2-10 grains (0.03-0.6 Gm.). 

Aloe Socotrlna— Aloes Socotrinae — Socotrine Aloes. — Origin. — Obtained from 
Aloe Perryi. 

Habitat. — Island of Socotra in the Strait of Bab-el-Mandeb. 

Description and Properties. — Hard masses, occasionally soft in the interior, opaque, 
yellowish-brown, orange-brown, or dark ruby-red, not greenish, translucent on the edges ; 
fracture resinous, somewhat conchoidal. When breathed upon it emits a fragrant, saf- 
fron-like odor. Taste peculiar, strongly bitter. Almost entirely soluble in alcohol and 
in 4 parts of boiling water. The aqueous solution becomes turbid on cooling and yields 
a deposit. Examined under the microscope, Socotrine aloes exhibits numerous crystals. 

The active principle of the various Aloes is alo'in, a neutral prin- 
ciple, varying in chemical composition and physical properties 
according to the species from which it is derived ; thus the sub- 
stance from Barbadoes aloes (barbaloin) is soluble in 60 parts of 
water, 20 parts of alcohol, and 470 parts of ether ; that from Soco- 
trine aloes (socaloin) is soluble in 60 parts of water, 30 parts of 
absolute alcohol, and 380 parts of ether. 

Nataloin, obtained from the unofficial Cape aloes, may be distinguished from the 
official aloin by heating the former with a drop or two of sulphuric acid and exposing it 
to the vapor of nitric acid, when nataloin changes to a blue color; barbalo'in and soca- 
loin are unaffected by this test. Nitric acid applied to barbaloin gives a crimson color, 
which rapidly fades ; the crimson color imparted to nataloin is permanent, while no 
color is produced when nitric acid is applied to socaloin. 

Dose. — J-10 grains (0.03-0.6 Gm.). 

Official Preparations. 

Extractum Aloes — Extr&cti Aloes — Extract of Aloes. — Dose, £-6 grains 
(0.03-0.4 Gm.). 

Aloe Purificata — Aloes Purificatse — Purified Aloes. — Dose, £-10 grains (0.03- 
0.6 Gm.). 

Extr3ctum Colocynthidis Comp6situm — ExtrScti Colocynthidis Compfisiti 
— Compound Extract of Colocynth. — Dose, 5-25 grains (0.3-1.6 Gm.). 

The following official preparations are prepared from purified aloes : 

PKlulae Aloes — Pilulas (ace.) Aloes — Pills of Aloes. — Dose, 1 to 4 pills. 

Pllulae Aloes et Asafcetidae — Pllulas (ace.) Aloes et Asafcetidae — Pills of 
Aloes and Asafetida. — Each pill contains about 1^ grains (0.085 Gm.) of each. — 
Dose, I to 5 pills. 

Pflulae Aloes et Fern— Pflulas (ace.) Aloes et Fern— Pills of Aloes and 
Iron. — Each pill contains about 1 grain (0.06 Gm.), each, of Aloes, dried Ferrous Sul- 
phate, and Aromatic Powder. — Dose, I to 4 pills. 

Pllulae Aloes et Mastiches— PKlulas (ace.) Aloes et Mastiches— Pills of 
Aloes and Mastich. — Each pill contains about 2 grains (0.12 Gm.), together with 
Mastich and Red Rose. — Dose, I to 3 pills. 

Pflulae Aloes et Myrrhae — Pllulas (ace.) Aloes et Myrrhae — Pills of Aloes 
and Myrrh. — Each pill contains 2 grains (0.12 Gm.), together with Myrrh and Aromatic 
Powder. — Dose, 1 to 3 pills. 



700 A TEXT-BOOK OF MA TERIA MEDICA. 

Pilulae Rhei Compositae — Pilulas (ace.) Rhei CompSsitas— Compound Pills 
of Rhubarb. — Each pill contains I grain (0.06 Gm.) of Aloes. — Dose, I to 3 pills. 

Tinctura Aloes — Tinctiirae Aloes' — Tincture of Aloes (10 per cent.). — Dose, 
£-1 fluidrachm (2.0-4.0 Cc). 

Tinctura Aloes et Myrrhae — Tinctiirae Aloes et Myrrhae — Tincture of Aloes 
and Myrrh (10 per cent, of each, with Glycerin 10 per cent.). — Dose, \-z\ fluidrachms 
(2.0-10.0 Cc). 

Tinctura Benzoini Comp6sita — Tinctiirae Benzolni CompSsitae — Compound 
Tincture of Benzoin (2 per cent, of Aloes). — Dose, 10-40 minims (0.6-2.6 Cc). 

Aloinum — Aloini — Aloin. U. S. P. — Origin. — A neutral principle obtained from 
several varieties of Aloes. 

Description and Properties. — Minute, acicular crystals, or a micro-crystalline pow- 
der, varying in color from yellow to yellowish-brown ; odorless or possessing a slight 
odor of aloes, of a characteristic, bitter taste, and permanent in the air. The solubilities 
of barbaloin and socaloln are given above. 

Dose. — 1-2 grains (0.03-0.12 Gm.). 

Physiological Action. — Aloes has no local action, although 
the drug is readily absorbed from ulcers or abraded surfaces. 

Internally, it is stomachic, increasing the secretions from the 
gastro-intestinal tract. It probably increases the secretion of bile. 
Its principal action appears to be upon the colon, the muscular 
coat of which it stimulates, besides augmenting the secretion from 
the large intestine. 

In from ten to fifteen hours after the ingestion of the drug it 
causes soft, dark-colored evacuations, its action being usually 
attended with more or less griping pain. 

The blood-supply to the lower bowel and pelvic viscera is 
increased by aloes ; and the drug, if used habitually, may bring 
on or aggravate hemorrhoids. The menstrual function is stimu- 
lated, the drug being quite a decided emmenagogue. 

Aloes is readily absorbed ; it is thrown off through the bowels 
and kidneys, and is found also in the milk. 

Therapeutics. — The principal use of aloes is as a purgative in 
habitual constipation due to a torpid condition of the large intestine. 
Jaundice resulting from hepatic congestion is well treated with 
aloes and blue pill. 

Pills of aloes and iron are useful adjuvants to other remedies 
in the treatment of chlorosis. Amenorrhea, which is such a common 
condition in chlorosis, is relieved by aloes. Pills of aloes and iron 
are equally valuable in menorrhagia arising from debility. 

Contraindications. — Aloes is ordinarily contraindicated in hem- 
orrhoids, although those cases attended with a mucous discharge 
are frequently benefited by it. The drug is considered objection- 



CATHARTICS. 701 

able in pregnancy, in persons of plethoric, bilious, or hemorrhagic 
constitution, and in menorrhagia of the strong and full-blooded. 

Administration. — When desired as a purgative, aloes in pill 
form is preferable to the liquid preparations, and the drug may 
be given alone or associated with other purgatives, tonics, or 
antispasmodics. 

Aloin is perhaps to be preferred to aloes, as it gripes less and 
may be given in smaller doses. It is less certain, however. 

As a purgative aloes ranks between rhubarb and senna. 

Fel Bovis— Fellis Bovis— Oxgall. V. S. P. 

(Fel Tauri.) 

Origin. — The fresh bile of Bos Taurus L. 

Description and Properties. — A brownish-green or dark-green, 
somewhat viscid liquid, having a peculiar, unpleasant odor and 
a disagreeable, bitter taste. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Official Preparation. 

FS1 Bovis Purificatum — FSllis Bovis Purificati — Purified Oxgall. — Descrip- 
tion and Properties. — A yellowish-green, soft solid, having a peculiar odor and a partly 
sweet and partly bitter taste. Very soluble in water and in alcohol. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Physiological Action and Therapeutics. — Like bile, oxgall 
augments the duodenal secretions, emulsionizes fats, and increases 
intestinal peristalsis. The drug liquefies the bile, and acts as a 
cholagogue and purgative. It is a useful cathartic when the stools 
are very offensive and of a light clay color, indicating a deficient 
biliary secretion. The drug is serviceable in jaundice due to 
obstruction of the common duct by inspissated bile or mucus. 
Impacted feces are readily removed by an enema containing 1 5 or 
20 grains (1. 0-1.3 Gm.) of oxgall. The drug is an efficient intes- 
tinal antiseptic, and may be beneficially employed for that purpose 
in typhoid fever and intestinal fermentation. 

Oxgall is usually given in pill form. 

Rheum— Rhei— Rhubarb. U. S. P. 

Origin. — The root of Rheum officinale Baillon, a plant indigen- 
ous in the western and northwestern portions of China. 

Description and Properties. — In cylindrical, conical, or flattish 



702 A TEXT-BOOK OF MA TERIA MEDICA. 

segments, deprived of the dark-brown, corky layer, smoothish or 
somewhat wrinkled, externally covered with a bright yellowish- 
brown powder, marked with white, elongated meshes, containing 
a white, rather spongy tissue, and a number of short, reddish- 
brown or brownish-yellow striae ; compact, hard ; fracture uneven ; 
internally white, with numerous red, irregularly-curved, and inter- 
rupted medullary rays, which are radially parallel only near the 
cambium line ; odor somewhat peculiar, aromatic ; taste bitter, some- 
what astringent. When chewed, rhubarb feels gritty between the 
teeth and imparts a yellow color to the saliva. Rhubarb which 
is very porous, or has a prominently mucilaginous taste, or is of 
a dark-brown color internally, should be rejected. 

The drug contains the following constituents : chrysophan 
(and chrysophanic acid), emodin, aparetin, phaeoretin, erythroretin, 
rheumic acid, and rheotannic acid, besides starch, calcium oxalate, 
etc. 

Dose. — 5-30 grains (0.32-1.94 Gm.). 

Official Preparations. 

Extr^ctum Rhei — ExtrScti Rhei — Extract of Rhubarb. — Dose, 3-15 grains 
(0.19-i.oGm.). 

Extractum Rhei Fluidum— Extr^cti Rhei Fluidi— Fluid Extract of Rhubarb 
(this preparation is used in Mistura Rhei et Sodae and in Syrupus Rhei). — Dose, 5-30 
minims (0.3-2.0 Cc). 

Pilulae Rhei — Pilulas (ace.) Rhei — Pills of Rhubarb. — Each pill contains 3 
grains (0.19 Gm.). Dose, I to 5 pills. 

Pilulae Rhei Comp8sitae — Pilulas (ace.) Rhei Comp8sitas — Compound 
Rhubarb Pills. — Each pill contains about 2 grains (0.12 Gm.) of Rhubarb, with puri- 
fied Aloes 1^ grains (0.09 Gm.), Myrrh, and Oil of Peppermint. Dose, I to 3 pills. 

Piilvis Rhei Comp5situs — Piilveris Rhei Compositi — Compound Rhubarb 
Powder (Gregory's Powder) — (25 per cent., with Magnesia and Ginger). — Dose, y^- 
I drachm (2.0-4.0 Gm.). 

Tinctura Rhei — Tinctiirae Rhei — Tincture of Rhubarb (10 per cent., with 
Cardamom). — Dose, J^-4 fluidrachms (2.0-15.0 Cc). 

Tinctura Rhei Aromattica — Tinctiirae Rhei Aromalticae — Aromatic Tincture 
of Rhubarb (20 per cent., with Cassia, Cinnamon, Cloves, and Nutmeg). — Dose, 1-3 
fluidrachms (4.0-12.0 Cc). 

This preparation is used to make Syrupus Rhei Aromaticus. 

Tinctura Rhei Diilcis— Tincturae Rhei Diilcis— Sweet Tincture of Rhubarb 
(10 per cent., with Glycyrrhiza, Anise, and Cardamom). — Dose, j^-4 fluidrachms (2.0- 
15.0 Cc). 

Mistura Rhei et Sodae — Misturae Rhei et Sddae— Mixture of Rhubarb and 
Soda. — Formula: Sodium Bicarbonate, 35; Fluid Extract of Rhubarb, 15; Fluid 
Extract of Ipecac, 3 ; Glycerin, 350 ; Spirit of Peppermint, 35 ; Water, to 1000. — Dose, 
\£-z fluidounces (8.0-60.0 Cc). 

Syrupus Rhei — Syrupi Rhei— Syrup of Rhubarb. — Formula: Fluid Extract 



CA THAR TICS. 703 

of Rhubarb, 100 ; Potassium Carbonate, 10 ; Spirit of Cinnamon, 4; Glycerin, 50; 
Water and Syrup, to 1000. — Dose, 1-4 fluidrachms (4.0— 15. o Cc.). 

Syrupus Rhei Arom^ticus — Syrupi Rhei Arom3tici — Aromatic Syrup of 
Rhubarb. — Formula: Aromatic Tincture of Rhubarb, 150; Syrup, 850. — Dose, %-z 
fluidrachms (2.0-8.0 Cc). 

Physiological Action and Therapeutics. — Rhubarb in mod- 
erate doses is a stomachic, acting similarly to the aromatic bitters, 
increasing secretion, peristalsis, vascularity, and absorption, thereby 
aiding digestion and serving as a tonic. In larger doses it is a 
mild cathartic, producing in from four to eight hours a soft yellow- 
ish-brown evacuation, not watery, which is not infrequently accom- 
panied by griping. 

It undoubtedly slightly increases the secretion of bile, though 
it is by no means an active hepatic stimulant. 

After full doses of rhubarb have been taken the purgative action 
is succeeded by quiescence of the bowels, the constipation being 
the result of the action of the astringent constituents of the rhu- 
barb. Small doses, however, taken daily, serve a useful purpose 
in relieving habitual constipation, without in the least impairing 
digestion. 

The drug is excreted with the feces, urine, perspiration, and 
milk ; the urine is slightly increased in amount, and together 
with the perspiration and milk, is colored yellow. The milk 
acquires a bitter taste and purgative properties. 

Rhubarb is one of the best purgatives for children suffering 
from diarrhea caused by irritating ingesta in the bowels or to cold ; 
it is also of value in some cases of dysentery. Summer diarrhea 
of children is often cured by some preparation of rhubarb alone, 
the diarrhea ceasing after a free purge by the drug. 

As a simple laxative for children it is a valuable remedy, owing 
to its secondary tonic and astringent effects, and is recommended 
as a laxative to expel thread-worms. 

When hemorrhoids are connected with constipation, much relief 
may be obtained by the gentle action of rhubarb. 

Administration. — Rhubarb is seldom given alone, because of 
the griping it occasions. For children the syrups are excellent 
preparations, and the mixture of rhubarb and soda is an appropri- 
ate remedy when the secretions of the stomach and bowels are 
unduly acid. 

In habitual constipation of adults the simple rhubarb pill is an 
efficient preparation. 



7°4 A TEXT-BOOK OF MA TERIA MEDICA. 

The choice of the preparation will depend largely upon the 
individual case. 

Euonymus— Euonymi— Euonymus. U. S. .P. 

(Wahoo.) 

Origin. — The bark of the root of Euonymus atropurpureus 
Jacquin, a shrub 6 to 10 or 14 feet (1.8 to 3 or 4.2 M.) high, found 
growing in shady woods of the northern and middle section of the 
United States east of the Mississippi. 

Description and Properties. — In quilled or curved pieces ^ to 
\ inch (2 to 5 Mm.) thick ; outer surface ash-gray, with blackish 
patches, detached in thin and small scales ; inner surface whitish 
or slightly tawny, smooth; fracture smooth, whitish, the inner 
layers of a laminated appearance ; nearly inodorous ; taste sweet- 
ish, somewhat bitter and acrid. 

The chief constituent of the drug is a resin, euonymin. 

Dose. — 1-2 drachms (4.0-8.0 Gm.). 

Official Preparation. 

Extractum Eu&nymi — Extr&cti Eu&nymi — Extract of Euonymus. — Dose, 
1-5 grains (0.06-0.3 Gm.). 

Eu6nymin (unofficial). — Origin. — A resin from the root and stem-bark of 
Euonymus atropurpureus Jacquin. 

Description and Properties. — A brown or greenish-brown hygroscopic powder with 
a feebly bitter taste, soluble in water, almost insoluble in alcohol and ether. 

Dose. — X~3 grains (0.01-0.19 Gm.). 

Physiological Action and Therapeutics. — Euonymus resem- 
bles rhubarb in its action, but is milder, small doses being stimu- 
lant to the stomach. The drug is an active hepatic stimulant, 
increasing the secretion of bile and facilitating its excretion into the 
intestine. It is excreted by the kidneys and broncho-pulmonary 
mucous membrane, being a mild diuretic and expectorant. Euony- 
mus is an excellent cathartic, particularly in cases of constipation 
attended with impaired functional activity of the liver. 

Euonymin is the preparation usually employed, although the 
official extract of euonymus is a reliable preparation. 

Tris— Tridis— Iris. U. S. I*. 

(Blue Flag.) 
Origin. — The rhizome and roots of Iris versicolor L., found 
growing in wet and swampy meadows from Canada southward to 
Florida and westward to Minnesota and Arkansas. 



CATHARTICS. 705 

Description and Properties. — Rhizome of horizontal growth, 
consisting of joints 2 to 4 inches (5 to 10 Cm.) long, cylindrical in 
the lower half, nattish near the upper extremity, and terminated 
by a circular scar, annulated from the leaf-sheaths, grayish-brown ; 
roots long, simple, crowded near the broad end ; odor slight ; taste 
acrid and nauseous. The drug contains an acrid resin, iridin, fixed 
oil, starch, gum, tannin, sugar, and indications of an alkaloid. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Official Preparations. 

Extr^ctum Iridis — Extr&cti Iridis — Extract of Iris. — Dose, 1-3 grains (0.06- 
0.2 Gm.). 

Extractum Iridis Fluidum — Extr5cti Iridis Fluidi — Fluid Extract of Iris. 
— Dose, 10-30 minims (0.6-2.0 Cc). 

Iridin (unofficial). — Dose, 1-3 grains (0.06-0.2 Gm.). 

Physiological Action and Therapeutics. — Iris is similar in its 
action to euonymus, although it is more apt to disturb the stomach 
and occasion nausea. It is actively purgative and possesses diu- 
retic properties. Like euonymus, it is a hepatic stimulant, and 
may be used for the same purposes as the former drug. It may 
be used in dropsy, and has been found to be an efficient cathartic 
in malarial and catarrhal jaundice and bilious remittent fever. It 
exerts a specific influence in enlargement of the thyroid gland. 

The dried drug is inert, the fluid extract and iridin being the 
most reliable preparations to use. 

Juglans— Juglandis— Juglans. TJ. S. JP. 

(Butternut.) 

Origin. — The bark of the root of Juglans cinerea L., a tree 
30 to 40 feet (9-12 M.) high, growing in forest and bottom-lands 
in Canada, and the greater portion of the United States westward 
to Missouri and Arkansas. 

Description and Properties. — In flat or curved pieces, from \ 
to \ inch (3 to 6 Mm.) thick ; the outer surface dark gray and 
nearly smooth or deprived of the soft cork, and deep brown ; the 
inner surface smooth and striate ; transverse fracture short, deli- 
cately checkered, whitish and brown ; odor feeble ; taste bitter and 
somewhat acrid. The drug contains a bitter, oily extractive, 
jugla7idic acid, two other acids, and various salts. 

Dose. — 1-2 drachms (4.0-8.0 Gm.). 
45 



706 A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparation. 

Extractum Juglandis — ExtrScti Juglandis —Extract of Juglans. — Dose, 5-30 
grains (0.3-2.0 Gm.). 

Physiological Action and Therapeutics. — The action and 
medical uses of this drug are analogous to those of euonymus. 

Lept&ndra— Leptandrae— Leptandra. V. S. jP. 

(Culver's Root.) 

Origin. — The rhizome and roots of Veronica virginica L., a 
plant indigenous in Canada, and in the United States as far west as 
the Mississippi Valley. 

Description and Properties. — Of horizontal growth, from 4 to 
6 inches (10 to 15 Cm.) long and about \ inch (6 Mm.) thick, some- 
what flattened, bent and branched, deep blackish-brown, with cup- 
shaped scars on the upper side, hard, of a woody fracture, with a 
thin, blackish bark, a hard, yellowish wood, and a large, purplish- 
brown, about six-rayed pith ; roots thin, wrinkled, very fragile ; 
inodorous ; taste bitter and feebly acrid. 

Leptandra contains a crystalline glucosid, leptandrin, besides 
tannin, gum, and a small quantity of volatile oil. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Official Preparations. 

Extractum Leptandrae — Extraxti Leptandrae — Extract of Leptandra. — Dose, 
1-5 grains (0.06-0.3 Gm.). 

Extractum Leptandrae Fluidum — Extralcti Leptandrae Fluidi — Fluid Ex- 
tract of Leptandra. — Dose, 15-60 minims (1.0-4.0 Cc). 

The Pilulae Catharticae Vegetabiles contain ^ grain (0.01 Gm.) of Extract of 
Leptandra to each pill. 

Leptandrin (unofficial). — Dose, 1-3 grains (0.06-0.2 Gm.). 

Physiological Action and Therapeutics. — The action of lep- 
tandra is similar to the actions of euonymus, iris, and juglans, the 
green root, however, being more of an irritant to the gastrointes- 
tinal tract, possessing marked emeto-cathartic properties. 

It is an active hepatic stimulant, and may be advantageously 
employed for the same purposes as euonymus, iris, etc. 

Senna— Sennse— Senna. TJ. S. JP. 

Origin. — The leaflets of Cassia acutifolia Delile (Alexandria 
senna) and of Cassia angustifolia Vahl (India senna), small shrubs 



CATHARTICS. 707 

found in Upper Egypt and southward to Nubia, Sennaar, and Kor- 
dofan, and farther westward in tropical Africa (Cassia acutifolia), and 
in Southwestern Arabia, along the Somali coast of Africa, and east- 
ward in Northern India (Cassia angustifolid). 

Description and Properties. — Alexandria senna consists of 
leaflets about I inch (25 Mm.) long and -§ inch (10 Mm.) broad, 
lanceolate or lance-oval, subcoriaceous, brittle, rather pointed, un- 
equally oblique at the base, entire, grayish-green, somewhat pubes- 
cent ; of a peculiar odor and a nauseous, bitter taste. 

India senna consists of leaflets 1 to 2 inches (2.5-5 Cm.) long 
and f to -J inch (10-15 Mm.) broad, lanceolate, acute, unequally 
oblique at the base, entire, thin, yellowish-green or dull green, 
nearly smooth ; odor peculiar, somewhat tea-like ; taste mucilagi- 
nous, bitter, and nauseous. 

Senna contains a sulphuretted glucosid, cathartic acid, to which 
the purgative properties of the drug are due. Senna also contains 
chrysophan, besides sennacrol and sennapicrin (two bitter princi- 
ples), catharto-mannite, mucilage, etc. 

Dose. — 10 grains-3 drachms (0.6-12.0 Gm.). 

Official Preparations. 

ConfSctio Sennae — Confectionis Sennae — Confection of Senna. — 10 per cent., 
with Cassia Fistula, Tamarind, Prune, Fig, Sugar, and Oil of Coriander. Dose, 1-3 
drachms (4.0-12.0 Gm.). 

Extralctum S&nnae Fluidum — Extr^cti SSnna Kluidi — Fluid Extract of 
Senna. — Dose, 10 minims-3 fiuidrachms (0.6-11.09 Cc). 

Infusum SSnnse Compbsitum — Infusi Sennae Comp6siti — Compound Infu- 
sion of Senna. — 6 per cent., with Manna and Magnesium Sulphate, each, 12 percent., 
and Fennel 2 per cent. Dose, 1-2%. fluidounces (30.0-75.0 Cc). 

Piilvis Glycyrrhizae Compfisitus — Pulveris Glycyrrhizae Comp6siti — Com- 
pound Powder of Glycyrrhiza. — Formula: Senna, 180; Glycyrrhiza, 236; Oil of 
Fennel, 4; Washed Sulphur, 80; Sugar, 500. Dose, yi-2. drachms (2.0-8.0 Gm.). 

Syrupus Sfinnae — Syrupi SSnnae — Syrup of Senna (25 per cent.). — Dose, )£-\ 
fluidounce (8.0-3.0 Cc). 

Cathartic Acid, Cathartinic Acid (unofficial). — Origin. — An active principle 
obtained from the leaves of various species of Cassia. 

Description and Properties. — It occurs as brown, hygroscopic scales, freely soluble in 
water and in alcohol. 

Dose. — 2-6 grains (o. 1 2-0.38 Gm.). 

Physiological Action and Therapeutics. — Senna is an active 
purgative, acting upon nearly the entire intestinal tract, increasing 
both peristalsis and intestinal secretion, although having but little 
effect upon the biliary secretion. It is apt to occasion much flatu- 
lence and griping unless it is associated with aromatics. Full doses 



708 A TEXT-BOOK OF MA TERIA MEDICA. 

open the bowels in from four to eight hours, producing one or 
more copious liquid, yellow stools, but never occasioning hyper- 
catharsis, and the purgation is not followed by constipation. 

An infusion of senna, if injected into the veins, excites both 
vomiting and purging. 

Some persons are so susceptible to the influence of senna as to 
be purged even by its odor. 

The drug, or some constituent of it, is eliminated by the urine, 
to which it imparts a red color, and by the milk, rendering it pur- 
gative. 

The various preparations of senna are very efficient purgatives 
in cases of simple constipation or in cases of fecal accumulation in 
the colon. 

Infusion of senna is an admirable purgative with which to suc- 
ceed the administration of blue pill. In cases of biliousness there is 
probably no better treatment than calomel or blue pill at night and 
infusion of senna in the morning. 

Habitual constipation and the constipation of pregnancy are safely 
and agreeably treated by compound liquorice powder. 

Administration. — Senna is seldom given alone, but is generally 
associated with some corrective to prevent griping. 

The infusion, compound liquorice powder, syrup, and confection 
of senna are employed. 

The compound liquorice powder and the confection being the 
mildest and pleasantest, the latter preparation, when coated with 
chocolate, is readily taken by children, and in this form is the well- 
known laxative " Tamar Indien!' 

HYDRAGOGUE PURGATIVES. 

These drugs are more active than the preceding class, pro- 
ducing an abundant secretion from the intestinal mucous mem- 
brane, removing a large quantity of water from the blood-vessels, 
and producing several copious, watery stools. 

Oleum Tiglii— Olei TIglii— Croton Oil- V. S. IP. 

Origin. — A fixed oil expressed from the seed of Croton Tiglium 
L., indigenous in Hindostan and some of the East Indian and 
Philippine islands. 

Description and Properties. — A pale-yellow or brownish-yel- 
low, somewhat viscid, and slightly fluorescent liquid, having a slight, 
fatty odor, and a mild, oily, afterward acrid and burning, taste 



CATHARTICS. 7°9 

{great caution is necessary in tasting). Croton oil should be kept 
in small, well-stoppered bottles, and should be handled with caution, 
for when applied to the skin it produces rubefaction or a pustular 
eruption. 

When fresh, croton oil is soluble in about 60 parts of alcohol, 
the solubility increasing by age. 

The drug contains several volatile acids, of which tiglinic acid 
is the characteristic one ; besides this, it contains lauric, myristic, 
palmitic, stearic, formic, acetic, isobutyric, and isovalerianic acids. 

Dose. — J-2 minims (0.01-0.12 Cc.) on a lump of sugar or mixed 
with some bland oil. 

Physiological Action. — Externally and Locally. — Croton oil is 
a powerful irritant when applied to the skin, exciting inflammation 
and quickly producing vesication, which rapidly merges into pus- 
tules closely resembling those of variola, and perhaps lasting 
several days. In many cases permanent cicatrices mark the sites 
of these pustules. 

If the drug be rubbed over the abdomen, it may produce pur- 
gation. The irritating action is wholly due to the free croton- 
oleic acid which the oil contains. 

Internally. — When a drop or two of croton oil is taken into the 
stomach it occasions a sense of heat in the epigastrium, which is 
soon succeeded by griping and abdominal pain, and in from half 
an hour to two hours after the ingestion of the drug there are pro- 
duced profuse watery stools, with considerable burning and irrita- 
tion about the anus. 

The drug greatly increases the vascularity of, and the secretion 
from, the gastro-intestinal tract, without specially influencing the 
biliary secretion. 

Large doses produce violent gastro-enteritis, hypercatharsis, 
with great prostration and collapse resembling that of cholera. 

In case of poisoning the stomach should be immediately evacu- 
ated, and demulcent drinks freely given. Opium and stimulants 
may be necessary. 

Therapeutics. — Externally and Locally. — The external use of 
croton oil is comparatively limited. 

Croton oil has been put to many other uses, but the results ob- 
tained are so unsatisfactory that it is needless to enumerate them. 

Internally. — The drug is used as a purgative, as a rule only in 
cases of emergency, and then a single dose is usually sufficient. 
It is employed in such cases as intestinal obstruction from accumu- 



JIO A TEXT-BOOK OF MATERIA MEDICA. 

lated feces produced by torpor of the bowels, diseases of the nervous 
system, lead-poisoning, etc. In lead colic it is probably superior to 
all other purgatives. 

Croton oil is sometimes employed for its revulsive action in 
apoplexy. 

As a purgative it is frequently given to the insane, because, on 
account of the smallness of the dose, it may be easily placed on 
the back of the tongue, where it is quickly swallowed reflexly. 

Contraindications. — The drug should never be given to preg- 
nant women, to children, nor to patients suffering from hemor- 
rhoids, peritonitis, gastritis, or enteritis. 

Administration. — Croton oil may be given in emulsion, or 
mixed with some bland oil, or dropped on a piece of loaf sugar, or 
in pill form. 

The best excipient for pills of croton oil is breadcrumb. 

Elaterinum— Elatenni— Elaterin. U. S. J\ 

Origin. — A neutral principle obtained from Elaterium, a sub- 
stance deposited by the juice of the fruit of Ecballium elaterium 
L., commonly known as " squirting cucumber," a vine growing in 
the Mediterranean regions of Europe, Africa, and Asia. 

Description and Properties. — Minute, white, hexagonal scales 
or prismatic crystals, without odor, and having a slightly acrid, 
bitter taste; permanent in the air; soluble in 4250 parts of water 
and 337 parts of alcohol. 

Dose. — sq - ^z grain (0.002-0.005 Gm.). 

Official Preparation. 

Trituratio Elatenni — Triturationis Elatenni — Trituration of Elaterin. — 
Dose, about f grain (0.05 Gm.). 

Physiological Action and Therapeutics. — Elaterin is the most 
powerful hydragogue purgative known. 

The drug greatly increases the salivary, gastric, and intestinal 
secretions, as well as those from the liver and pancreas. 

It is a violent purgative, whether given internally or injected 
subcutaneously, producing abundant watery evacuations attended 
with much griping pain and great prostration. 

Elaterin is indicated where profuse serous discharges are de- 
sired, as in cases of congestion of the brain and lungs, ascites, and 
chronic nephritis. 



CATHARTICS. 711 

Contraindications. — The drug is not permissible in inflamma- 
tory conditions of the gastro-intestinal tract, nor in pregnancy, 
and it should be administered with much care, if at all, in heart 
disease. 

Administration. — The drug may be given in pill form, in alco- 
holic solution, or in the form of the trituration. Elaterin varies 
greatly in strength, which suggests caution in its use. 



Cambogia— Cambogiae— Gamboge. U. S. JR. 

Origin. — A gum-resin obtained from Garcinia Hanburii Hooker 
filius, a medium-sized tree, indigenous in Siam, Cambodia, and 
Cochin China. 

Description and Properties. — In cylindrical pieces, sometimes 
hollow in the center, 1 to 2 inches (2 to 5 Cm.) in diameter, longi- 
tudinally striate on the surface ; fracture flattish-conchoidal, of a 
waxy luster, orange-red ; in powder bright yellow ; inodorous ; 
taste very acrid; the powder sternutatory. Gamboge is partly 
soluble in alcohol and in ether. 

Dose. — 1-5 grains (0.06-0.32 Gm.). 

Official Preparation. 

Pllulae Cath3rticae Compfisitae — Pllulas (ace.) Cathatrticas Comp6sitas — 
Compound Cathartic Pills. — Dose, 1-3 pills. 

Physiological Action and Therapeutics. — Gamboge is a vio- 
lent hydragogue purgative, exciting active peristalsis and greatly 
augmenting the secretion from the intestinal glands, although not 
increasing the secretion of bile. Small and repeated doses are 
slightly diuretic, coloring the urine yellow. 

Gamboge is seldom given alone, being usually associated with 
other purgatives. It is used in combination when a hydragogue 
action by the kidneys as well as the bowels is desired. It is 
thought to be of use in hepatic congestion arising from malarial 
causes. The drug is an efficient anthelmintic, and is occasionally 
prescribed with vermicide medicines. 



712 A TEXT-BOOK OF MATERIA MEDIC A. 

SALINES. 

Magnesii Citras Effervescens— Magnesii Citratis 
Effervescentis— Effervescent Magnesium Ci- 
trate. U. S. JP. 

Formula: Magnesium Carbonate, 10 ; Citric Acid, 46 ; Sodium 
Bicarbonate, 34 ; Sugar, 8 ; Alcohol and Distilled Water, a suf- 
ficient quantity. 

Description and Properties. — A white, coarsely granular salt, 
without odor, and having a mildly acidulous, refreshing taste. 
Deliquescent on exposure to the air. Soluble, with copious effer- 
vescence, in 2 parts of water ; almost insoluble in alcohol. The 
product should be kept in well-closed vessels. 

Dose. — J-i ounce (8.0-32.0 Gm.). 

Liquor Magnesii Citratis— Liquoris Magnesii Citratis 
—Solution of Magnesium Citrate. T7. S. -P. 

Formula: Dissolve Magnesium Carbonate, 15, in a solution of 
Citric Acid, 30 ; add Syrup of Citric Acid, 60 ; then Crystals of 
Potassium Bicarbonate, 25. Cork the bottle and wire immediately. 
The product effervesces when uncorked. 

Dose. — 2-8 fluidounces (60.0-237.0 Cc). 

Magnesii Sulphas— Magnesii Sulphatis— Magne- 
sium Sulphate. TJ. S. I*, 

(Epsom Salt.) 

Origin. — Obtained by the action of Sulphuric Acid upon native 
Magnesium Carbonate, treated with Water, filtered, and the filtrate 
evaporated to crystallization. 

Description and Properties. — Small, colorless, rhombic prisms 
or acicular crystals, without odor, and having a cooling, saline, 
and bitter taste; slowly efflorescent in dry air. Soluble in 1.5 
parts of water; insoluble in alcohol. 

Dose. — l— 1 ounce (8.0-32.0 Gm.). 

Antagonists and Incompatibles. — Magnesium sulphate is in- 
compatible with alkaline carbonates, phosphoric acid, phosphates, 
lead acetate, silver nitrate, and lime water. 

Synergists. — Saline purgatives. 

Potassii Sulphas— Potassii Sulphatis— Potassium 
Sulphate. U.S. P. 

Origin. — Prepared by adding Potassium Carbonate to Acid 
Potassium Sulphate. 



CATHARTICS. 713 

Description and Properties. — Hard, colorless, transparent, six- 
sided, rhombic prisms terminated by pyramids, or in white powder ; 
odorless, and having a somewhat bitter, saline taste. Permanent 
in the air. Soluble in about 9.5 parts of water, insoluble in 
alcohol. 

Dose. — j— 4 drachms (2.0-16.0 Gm.). 

Potassii et Sodii Tartras— Potassii et Sodii Tartratis 
—Potassium and Sodium Tartrate. U. S. JP. 

(Rochelle Salt.) 

Origin. — Prepared by adding Acid Potassium Tartrate to a hot 
solution of Sodium Carbonate. 

Description and Properties. — Colorless, transparent rhombic 
prisms, or a white powder, odorless, and having a cooling, saline 
taste. The crystals slightly effloresce in dry air. Soluble in 1.4 
parts of water, almost insoluble in alcohol. 

Dose. — 30 grains-i ounce (2.0-32.0 Gm.). 

Official Preparation. 

Ptilvis Efferv&scens Comp6situs — Ptilveris EffervescSntis Comp6siti — 
Compound Effervescing Powder (Seidlitz Powder). — Each powder has of Ro- 
chelle Salt, 120 grains (8.0 Gm.) ; of Sodium Bicarbonate, 40 grains (3.0 Gm.), mixed 
in a blue paper; and of Tartaric Acid, 35 grains (2.26 Gm.), in a white paper. 

Dose. — One or two of each dissolved separately in separate quantities of water, the 
solutions poured together and drunk while effervescing. 

Sodii Phosphas— Sodii Phosphatis— Sodium Phos- 
phate. U.S.I*. 

(Sodium Orthophosphate.) 

Origin. — Prepared by digesting Bone Ash with Sulphuric Acid. 
The solution is filtered, and to it is added Sodium Carbonate, and 
the filtrate evaporated to crystallization. 

Description and Properties. — Large, colorless, monoclinic 
prisms, odorless, and having a cooling, saline taste. The crys- 
tals effloresce in the air, and gradually lose 5 molecules of water 
of crystallization. Soluble in 5.8 parts of water; insoluble in 
alcohol. Sodium phosphate should be kept in well-stoppered 
bottles, in a cool place. 

Dose. — 5 grains-i ounce (0.32-32.0 Gm.). 



714 A TEXT-BOOK OF MATERIA MEDIC A. 

Sodii Sulphas— Sodii Sulphatis— Sodium Sulphate. 

XT. S. JP. 

(Glauber's Salt.) 

Origin. — The residue left in the manufacture of Hydrochloric 
Acid from Salt is neutralized with Sodium Carbonate. 

Description and Properties. — Large, colorless, transparent, 
monoclinic prisms or granular crystals ; odorless, and having a 
bitter, saline taste. The salt effloresces rapidly in the air, and 
finally loses all its water of crystallization. Soluble in 2.8 parts 
of water and in glycerin ; insoluble in alcohol. 

Dose. — 1-8 drachms (4.0-32.0 Gm.). 



Physiological Action and Therapeutics of the Salines. — These 
preparations greatly augment the amount of fluid in the intestinal 
canal. This increase of fluid is not a secretion, but a result of the 
high osmotic equivalent of the salts which tends to draw the body- 
fluids into the intestines, while hindering to a certain extent absorp- 
tion of fluid from the intestines. The purgative influence is really 
due to the mechanical action of the fluid in the intestines. 

Save the sulphate and phosphate of sodium, which are mild he- 
patic stimulants, the salines have no effect upon the biliary secretions. 

The sodium salts are more efficient than the potassium salts as 
purgatives, owing to their higher osmotic equivalents. 

Purgation by the salines is painless, and occurs usually in from 
two to three hours after administration, there being ordinarily two 
or three watery evacuations. 

In cases of habitual constipation, particularly that associated 
with the gouty diathesis, there are no better purgatives than the salts 
of sodium or mineral waters containing them, such as Carlsbad, 
Marienbad, Hunyadi Janos, etc. 

For children there is no better purgative than sodium phos- 
phate, especially where the stools show a deficiency of bile. In 
duodenal catarrh excellent results are obtained by this drug ; also 
in chronic rheumatism, and to retard the formation of biliary calculi. 

Concentrated saline purgatives are efficient remedies for the 
removal of dropsical and pleuritic effusions. 

Magnesium sulphate, combined with dilute sulphuric acid, is 
the most efficient treatment in cases of chronic lead-poisoning. 

Rochelle salt and Seidlitz powder are pleasant and useful 
purgatives in cases of biliousness, migraine, etc. Solution of mag- 



CATHARTICS. 715 

nesium citrate is used for the same purpose, but, while very 
palatable and acceptable to the stomach, is not always reliable, 
besides being apt to occasion slight griping. 

Administration. — The salines should be taken dissolved in 
as concentrated a solution as possible, and ordinarily should be 
administered in the morning, when the stomach is empty. 

DRASTIC PURGATIVES. 

These drugs are even harsher in their action than hydragogue 
purgatives, exciting violent peristalsis, and in large doses producing 
gastro-enteritis and all the symptoms occasioned by an irritant 
poison. The evacuations produced by these drugs are numerous, 
copious, and watery, attended with much griping pain, tenesmus, 
and borborygmi. 

Colocynthis— Colocynthidis-Colocynth. U. S. .P. 

Origin. — The fruit of Citrullus Colocynthis Schroder, deprived 
of its rind. The colocynth plant is indigenous in Japan and is 
cultivated and naturalized in Spain. 

Description and Properties. — From 2 to 4 inches (5-10 Gm.) 
in diameter ; globular ; white or yellowish-white, light, spongy ; 
readily breaking into three wedge-shaped pieces, each containing, 
near the rounded surface, many flat, ovate, brown seeds ; inodor- 
ous ; taste intensely bitter. 

The active constituent of colocynth is colocynthin, a glucosid, 
of which there is present about 2 per cent. Colocynth also con- 
tains resin, gum, and an amyloid principle. 

Dose. — 5-10 grains (0.3-0.6 Gm.). 

Official Preparations. 

Extr&ctum Colocynthidis— Extr^cti Colocynthidis— Extract of Colocynth. 
Dose, \-2 grains (0.03-0. 1 3 Gm.). 

Extr3ctum Colocynthidis Compftsitum— ExtrScti Colocynthidis Comp6siti 
— Compound Extract of Colocynth. — Extract of Colocynth 16 per cent., with Aloes 
Scammony, Cardamom, and Soap. 

Dose. — 5-25 grains (0.3-1.6 Gm.). 

Compound Extract of Colocynth enters into the following pills : 

Pilulae Cath3rticae Comp6sitae (8 per cent.). 

Pflulae CathSrticae Vegetables (6 per cent.). 

Physiological Action and Therapeutics. — The action of colo- 
cynth is very similar to that of elaterin. In small doses, however, 



yi6 A TEXT-BOOK OF MATERIA MEDICA. 

it rather acts as a stomachic, improving the appetite and augment- 
ing the secretions of the whole gastro-intestinal tract. Colocynth 
is quite a decided hepatic stimulant and cholagogue. 

Pills containing colocynth are useful to produce abundant 
watery evacuations, as is necessary sometimes in the treatment of 
hepatic and renal diseases where there is constipation and ascites. 

The drug should be employed only when there is some marked 
indication for its use, as colocynth, like the other drastics, is too 
irritant for habitual use. 

Gastro-intestinal inflammation, pregnancy, etc., would contra- 
indicate its use. 

Jalapa— Jalapae— Jalap. U. S. JP. 

Origin. — The tuberous root of Ipomoea Jalapa Nuttall, a twin- 
ing herbaceous perennial growing in damp and shady woods on 
the eastern slope of the Mexican Andes. It has been introduced 
into India and Jamaica. 

Description and Properties. — Napiform, pyriform, or oblong, 
varying in size, the large roots incised, more or less wrinkled, dark 
brown, with lighter-colored spots and short, transverse ridges ; 
hard, compact, internally pale grayish-brown, with numerous con- 
centric circles composed of small resin-cells ; fracture resinous, not 
fibrous ; odor slight, but peculiar, smoky, and sweetish ; taste 
sweetish and acrid. 

Jalap contains two resins, one hard, the other soft, the former, 
jalapin and the latter, convolvulin, are the active principles of the 
drug. According to the U. S. Pharmacopoeia, there must be not 
less than 12 per cent, of resin, of which not less than 10 per cent, 
must be soluble in ether. 

Dose. — 5-30 grains (0.32-2.0 Gm.). 

Official Preparations. 

Extratctum Jalapae — Extraxti Jalapae — Extract of Jalap. — Dose, 2-5 grains 
(0.13-0.3 Gm.). 

Ptilvis Jalapae Comp6situs — Ptilveris Jalapae Comp6siti — Compound Jalap 
Powder (35 per cent., with Potassium Bitartrate). — Dose, 15-60 grains (1.0-4.0 Gm.). 

Resina Jalapae — Resinae Jalapae — Resin of Jalap. — Description and Proper- 
ties. — Yellowish-brown or brown masses or fragments, breaking with a resinous, glossy- 
fracture, translucent at the edges, or a yellowish-gray or yellowish-brown powder, having 
a slight, peculiar odor, and a somewhat acrid taste. Permanent in the air. Soluble in 
alcohol in all proportions. 

Dose. — 2-5 grains (0.13-0.3 Gm.). 

Extract of Jalap is one of the ingredients of Pilulae Cath&rticae Compdsitae 
and Pilulae Catharticae Vegetables. 



CATHARTICS. 717 

Physiological Action and Therapeutics. — The purgative 
action of jalap is developed in the duodenum, where it comes in 
contact with the bile. The secretion from the intestinal glands is 
greatly augmented, as well as the vascularity an'd peristalsis of the 
intestines. The biliary flow is but little affected. 

Purgation is produced by jalap in three or four hours, the 
evacuations being profuse and watery and attended with griping 
pain. 

Jalap — or, preferably, the compound jalap powder — is a reliable 
hydragogue cathartic for the removal of dropsical effusions, being 
especially appropriate for nephritic patients. 

Small doses of jalap are serviceable in constipation due to de- 
ficient intestinal secretion. 

The drug is frequently associated with anthelmintic medicines 
as a vermifuge. 

Scammonium— Scammonii— Scammony. IT. S. I*. 

Origin. — A resinous exudation from the living root of Convol- 
vulus Scammonia L., a herbaceous, twining perennial, growing 
in Syria, Asia Minor, and Greece. 

Description and Properties. — Occurring in irregular angular 
pieces or circular cakes, greenish-gray or blackish, internally por- 
ous, and breaking with an angular fracture, of a resinous luster ; 
odor peculiar, somewhat cheese-like ; taste slightly acrid ; powder 
gray or greenish-gray. 

It contains a glycoside, jalapin, which is the active principle, 
besides gum, starch, etc. 

Dose. — 1— 1 5 grains (0.06-1.0 Gm.). 

Official Preparation. 

Resina Scammonii — Resinae Scammonii — Resin of Scammony. — Descrip- 
tion and Properties. — Yellowish-brown or brownish-yellow masses or fragments, break- 
ing with a glossy, resinous fracture, translucent at the edges, or a yellowish-white or 
grayish-white powder, having a faint, peculiar odor, and a slight, peculiar taste. Soluble 
in alcohol in all proportions. 

Dose. — 1-8 grains (0.06-0.5 Gm.). 

Physiological Action and Therapeutics. — The action of scam- 
mony is identical with that of jalap, save that it stimulates the 
muscular coat of the intestines more, producing more irritation 
and griping than jalap, though not increasing secretion so much 
as the latter drug. 



718 A TEXT-BOOK OF MATERIA MEDICA. 

The therapeutics are the same as for jalap. 

The drug may be given in powder, emulsion, or in milk, but is 
inactive in pilular form. 

Podophyllum— Podophylli— Podophyllum. U. S. JP. 

(May Apple.) 

Origin. — The rhizome and roots of Podophyllum peltatum L., an 
herbaceous perennial growing in rich woodlands in Canada and the 
United States. 

Description and Properties. — Of horizontal growth, consisting 
of joints about 2 inches (5 Cm.) long, flattish cylindrical, about 
\ inch (6 Mm.) thick, but somewhat enlarged at the end, which 
has a circular scar on the upper side, a tuft of about ten nearly 
simple, fragile roots on the lower side, and is sometimes branched 
laterally ; smooth or somewhat wrinkled, orange-brown, internally 
white and mealy, with a circle of small wood-bundles ; pith large ; 
nearly inodorous ; taste sweetish, somewhat bitter and acrid. 

' Podophyllum contains a resin, podophyllin, composed princi- 
pally of podophyllotoxin, which is probably a mixture of picropodo- 
phyllin, the purgative principle, and podophyllinic acid, an inactive 
resin acid. Among other constituents of the drug are several 
minor resins and a coloring principle. 

Dose. — 5-20 grains (0.32-1.29 Gm.). 

Official Preparations. 

ExtrSctum Podophylli — Extr&cti Podophylli — Extract of Podophyllum. — 
Dose, 1-3 grains (0.06-0.2 Gm.) 

ExtrSctum Podophylli Fluidum — ExtrScti Podophylli Fluidi— Fluid Ex- 
tract of Podophyllum. — Dose, 5-20 minims (0.32-1.29 Cc). 

Resina Podophylli — Resinae Podophylli — Resin of Podophyllum. — Descrip- 
tion and Properties. — An amorphous powder, varying in color from grayish-white to 
pale greenish-yellow or yellowish-green, turning darker when exposed to heat; having 
a slight peculiar odor and a peculiar, faintly bitter taste; permanent in the air; soluble 
in alcohol in all proportions. 

Dose. — i-l grain (0.008-0.06 Gm.). 

PodophyllotSxin (unofficial). — Dose, x^q-jV grain (0.0006-0.006 Gm.). 

Physiological Action and Therapeutics. — The powdered root 
is an irritant to the skin, and when inhaled occasions a decided 
irritation of the eyes and respiratory passages. It is absorbed 
when applied to ulcers and raw surfaces, producing its character- 
istic purgative effects. The drug is a gastro-intestinal irritant, being 



ANTHELMINTICS. 7 1 9 

apt to excite nausea, in full doses producing salivation and greatly 
augmenting the intestinal secretions, and especially the bile. Under 
full doses of podophyllum there is marked peristalsis, attended 
with severe griping pains, and in the course of ten or twelve hours 
there is produced a complete evacuation of the bowels, the feces 
being liquid and deeply stained with bile. 

The drug being one of the most active hepatic stimulants and 
cholagogues in the Pharmacopoeia, it is a peculiarly appropriate 
remedy in that condition known as torpor of the liver. The con- 
stipatioji attending hepatic cirrhosis and cancer, as well as that from 
any hepatic disorder, is well treated by podophyllum. 

The slowness and completeness of its action, together with its 
property of stimulating the functional activity of the liver, renders 
the drug extremely serviceable in the treatment of habitual consti- 
pation from any cause. 

It should, however, be associated with antispasmodics, such as 
hyoscyamus or belladonna, to overcome its griping. When asso- 
ciated with other purgatives care should be exercised to select 
those only which, like itself, are tardy in their action. 

Owing to the susceptibility of certain persons to the drug, 
the dosage should be small at first and gradually increased as 
necessary. 



GROUP XV.— ANTHELMINTICS. 
Anthelmintics are remedies which kill or expel intestinal 
worms. Those drugs which kill the parasites are called vermi- 
cides, and those which simply promote their expulsion are called 
vermifuges} 

The vermicides are — 

Aspidium, Kamala, 

Chenopodium, Oleum Terebinthinae,* 

Cusso, Pepo, 

Granatum, Santonica. 

The vermifuges are — 

Calomel,* Spigelia. 

Hydragogue Purgatives,* 
Anthelmintics are here divided according to the kind of intesti- 
nal parasite against which they are employed. 

The Oxyuris vermicularis is the small worm, often called seat- 

1 Drugs marked with an asterisk (*) are considered elsewhere. 



720 A TEXT-BOOK OF MATERIA MEDICA. 

worm or thread-worm, that infests the large intestine and rectum. 
The Ascaris lumbricoides is the common round-worm, found chiefly 
in the small intestine. 

The Tcenice are the tape-worms. 

Remedies employed against the Oxyuris vermicularis : 
A weak solution of Carbolic Acid,* Lime Water,* 
Infusion of Quassia,* Calomel,* 

Decoction of Aloes,* Oleum Terebinthinae.* 

Remedies employed against the Ascaris lumbricoides : 
Chenopodium, Calomel,* 

Santonica, Hydragogue Purgatives,* 

Spigelia, Oleum Terebinthinae.* 

Remedies employed against the Tcenia Solium and other varieties 
of Tcenia: 
Aspidium, Kamala, 

Cusso, Pepo, 

Granatum, Oleum Terebinthinae.* 

Chenopodium— Chenopodii— Chenopodium. JJ. S.I*. 

(American Wormseed.) 

Origin. — The fruit of Chenopodium ambrosioides L., and the 
variety anthelminticum Gray, plants indigenous in the West Indies, 
and Central and South America, and naturalized in the United 
States. 

Description and Properties. — Nearly -^ inch (2 Mm.) in diam- 
eter, depressed globular, dull greenish or brownish, the integu- 
ments friable, and containing a lenticular, obtusely-edged, glossy, 
black seed. It has a peculiar, somewhat terebinthinate odor, and 
a bitterish, pungent taste. It contains a volatile oil, to which its 
medical properties are due. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

Oleum Chenopodii— Olei Chenopodii— Oleum Che- 
nopodii. TI. S. P. 

(Oil of American Wormseed.) 

Origin. — A volatile oil distilled from Chenopodium. 

Description and Properties. — A thin, colorless or yellowish 
liquid, having a peculiar penetrating, somewhat camphoraceous 
odor, and a pungent and bitterish taste. 

Dose. — 2-10 minims (0.12-0.6 Cc). 



ANTHELMINTICS. 721 

Physiological Action and Therapeutics. — Both the powdered 
seed and the oil are efficient anthelmintics, particularly useful to 
expel round-worms (Ascarides lumbricoides) from children. The 
drug should invariably be followed by a brisk cathartic. The 
powder may be given suspended in molasses, or the oil may be 
given dropped upon loaf-sugar, or in the form of an emulsion, or 
enclosed in capsules. 

Santonica— Santonicae— Santonica. JJ. S. JP. 

(Levant Wormseed.) 

Origin. — The unexpanded flower-heads of Artemisia panciflora 
Weber, a plant growing in Asia and exclusively collected in North- 
ern Turkestan. 

Description and Properties. — From -^ to \ inch (2 to 3 Mm.) 
long, oblong-ovoid, obtuse, smooth, somewhat glossy, grayish- 
green, after exposure to light brownish-green, consisting of an in- 
volucre of about twelve to eighteen closely imbricated, glandular 
scales with a broad midrib, enclosing four or five rudimentary 
florets ; odor strong, peculiar, somewhat camphoraceous ; taste 
aromatic and bitter. The drug contains about 2 per cent, of a 
neutral principle, santonin, to which its anthelmintic properties are 
due. It also contains about 1 per cent, of an unimportant volatile 
oil. 

Dose. — 10-60 grains (0.6-4.0 Gm.). 

SantonTnum— Santonlni— Santonin. U. S. P. 

Origin. — A neutral principle obtained from Santonica. 

Description and Properties. — Colorless, shining, flattened, pris- 
matic crystals, odorless, and nearly tasteless when first put into the 
mouth, but afterward developing a bitter taste ; not altered by ex- 
posure to air, but turning yellow on exposure to light. Nearly 
insoluble in cold water ; soluble in 40 parts of alcohol. Santonin 
should be kept in dark, amber-colored vials, and should not be 
exposed to light. 

Dose. — |— 1 grain (0.016-0.06 Gm.) for a child; 1-5 grains 
(0.06-0.32 Gm.) for an adult. 

Official Preparation. 

TrocMsci Santonlni — TrochTscos (ace.) Santonlni — Troches of Santonin. — 
Each troche contains \ grain (0.03 Gm.). — Dose, 2 (child) to 10 troches (adult). 
46 



722 A TEXT-BOOK OF MATERIA MEDICA. 

Physiological Action and Therapeutics. — In full or large 
doses santonin may excite nausea or vomiting, with abdominal 
pain, diarrhea, eructations, borborygmi, and great thirst. It readily 
enters the blood, where it exists as sodium santoninate. Large 
doses may cause giddiness, headache, hallucinations of smell and 
taste, tremors, and a species of depression, the combination of 
symptoms forming what is called santonin intoxication. 

The drug is chiefly eliminated through the kidneys, small 
amounts of santonin even imparting to the urine a distinct yellow 
color if the urine is acid, and a decided purplish or even red color 
if the urine is alkaline. Under certain circumstances when the 
urine is decidedly alkaline, as in cases of cystitis, the administra- 
tion of santonin may produce so marked a discoloration of the 
urine as to suggest hematuria. 

Probably the most remarkable phenomenon attending the inges- 
tion of medicinal doses of santonin is that of xanthopsia or yellow 
vision, which may continue for several hours. According to Rose, 
" there occasionally appears before the peculiar yellow sight, after 
large doses of santonin, a violet color of the field of vision : the 
intensity of this color is in proportion to the darkness of the objects 
looked at. All light objects, such as windows, paper, etc., appear 
actually yellow. Red and blue appear often in their complementary 
colors, orange and green, so that carmine-red appears pale, madder- 
red a bronze color, and the sky and blue objects green. This> 
however, is not always the case, and it has been noticed after the 
employment of santonin that red appears violet or light, and dark 
objects appear orange to one person, and to another green." 
(Quoted from Lewin.) This peculiar effect of santonin is due, 
according to Rose, to a nervous change in the retina or in the brain. 

Affections of the skin — e. g. urticaria — have occasionally fol- 
lowed the administration of santonin. Decidedly poisonous effects 
have sometimes been produced by comparatively small amounts of 
the drug. The symptoms of a fatal case from over-dose of santonin 
were convulsions accompanied by unconsciousness, twitching of the 
eyeballs, dilated pupils, cold sweat, weak pulse, feeble respiration, 
and, after some hours, sudden death. 

In case of poisoning by santonin the remedial measures are in- 
ternal and external stimulants, eliminants, and artificial respiration. 
Santonin is certainly a most efficient remedy against the ascaris, 
and to a less extent it is of use against the oxyuris. It has no 
effect on the tcenia. 



ANTHELMINTICS. 723 

The drug should be given on an empty stomach, preferably at night, 
either alone or associated with calomel, and followed in two or three 
hours by castor oil or other brisk cathartic. It may be administered 
in the form of a powder mixed with sugar or jelly, or in pills or 
capsules. Troches of santonin are much used and are very efficient. 

Spigelia— Spigeliae— Spigelia. TJ. 8. JP. 

(PlNKROOT.) 

Origin. — The rhizome and roots of Spigelia marilandica L., 
a plant growing in rich shady woods, chiefly in the southern part 
of the United States, but found as far northward as Pennsylvania 
and Wisconsin. 

Description and Properties. — Of horizontal growth, about 2 
inches (5 Cm.) or more long, about \ inch (3 Mm.) thick, dark 
purplish-brown, bent, somewhat branched on the upper side, with 
cup-shaped scars ; on the lower side with numerous thin, brittle, 
light-colored roots about 4 inches (10 Cm.) long; the rhizome 
internally with a whitish wood and a pith which is usually dark 
colored or decayed ; odor somewhat aromatic ; taste sweetish, 
bitter, and pungent. 

It contains a volatile alkaloid, spigeline, which is the active 
principle. 

Dose. — 1-2 drachms (1.0-8.0 Gm.). 

Official Preparation. 
Extraxtum Spigeliae Fltiidum — Extraxti Spigeliae Fltiidi — Fluid Extract 
of Spigelia. — Dose, \-2 fluidrachms ( 1. 0-8.0 Cc). 

Physiological Action and Therapeutics. — Spigelia is a pow- 
erful anthelmintic, being a decided vermifuge against the Ascaris 
lumbricoidcs. When given alone and in full doses it may produce 
symptoms of narcotic poisoning. This may be obviated by asso- 
ciating it with cathartics and aromatics. 

The drug may be administered in the form of a tea, associated 
with senna, fennel, or other aromatics. The fluid extract is a reli- 
able preparation. 

Remedies employed against the different varieties of Tcznia : 
AspTdium— Aspldii— Aspidium. TJ. 8. J?. 

(Male Fern.) 
Origin. — The rhizome of Dryoptcris Filix mas Schott and of 
Dryopteris marginalis Gray, plants indigenous in North America, 



724 



A TEXT-BOOK OF MATERIA MEDICA. 



a portion of South America, Asia, Europe, and some parts of 
Africa. 

Description and Properties. — From 3 to 6 inches (7 to 15 Cm.) 
long, \ to 1 inch (12 to 25 Mm.) thick, and, together with the 
closely imbricated, dark-brown, roundish, and slightly curved 
stipe-remnants, 2 to 3 inches (50 to 75 Mm.) in diameter ; densely 
covered with brown, glossy, transparent, and soft, chaffy scales ; 
internally pale green, rather spongy ; vascular bundles about ten 
(Dryopteris Filix mas) or six [Dryopteris marginalis) in number, 
arranged in an interrupted circle ; odor slight, but disagreeable ; 
taste sweetish, acrid, somewhat bitter, astringent, and nauseous. 
Aspidium contains filicic acid, tannaspidic acid, pteritannic acid, 
filicin (filicic acid anhydride), fixed oil, a trace of volatile oil, and 
chlorophyl. 

Dose. — J-2 drachms (2.0-8.0 Gm.). 

Official Preparation. 

Oleoresina Aspidii — Oleoresinae Aspidii — Oleoresin of Aspidium. — Dose, 
|-l fluidrachm (1.0-4.0 Cc). 

Note. — Oleoresin of aspidium usually deposits, on standing, a granular crystalline 
substance. This should be thoroughly mixed with the liquid portion before use. The 
oleoresin should be kept in well-stoppered bottles. 

Physiological Action and Therapeutics. — Aspidium is the 
most reliable tceniacide known to materia medica. Though it is 
employed against both the armed and unarmed varieties of tape- 
worm, it is nevertheless against the latter that it is specially effec- 
tive. In the cases of armed taeniae special precautions must be 
taken to ensure success. 

The drug possesses tonic and astringent properties, and if taken 
in very large doses may occasion nausea, vomiting, diarrhea, and 
gastric and abdominal pains. 

Several fatal cases of poisoning have occurred, and it is believed 
that the fatalities were due not so much to excessive dose as to 
increased absorption of the drug through the influence of the 
castor oil that had been administered with it. 

When given for the expulsion of tape-worm the bowels should 
first be emptied by a castor-oil purge, and then the oleoresin be 
administered in gelatin capsules, or in emulsion. 

Previous to the exhibition of the anthelmintic the patient should 
for at least twenty-four hours live on exceedingly spare diet, and 
the medicine then be given in the morning fasting. A few hours 



ANTHELMINTICS. 725 

later an active purge of about 1 ounce (30.0 Cc.) of castor oil or 
calomel and jalap should be given to expel the dead worm, which 
should be carefully examined for the head. If the head did not 
pass, the treatment should be repeated the following day or soon 
after. 

Cusso— Cusso— Kousso. U. S. JP. 

(Brayera.) 

Origin. — The female inflorescence of Hagenia Abyssinica (Bruce) 
Gmelin, a handsome tree 40 to 50 feet (12 to 18 M.) high, in- 
digenous on the table-land and in the mountainous districts of 
Abyssinia. 

Description and Properties. — In bundles, rolls, or compressed 
clusters consisting of panicles about 10 inches (25.0 Cm.) long, 
with a sheathing bract at the base of each branch ; the two round- 
ish bracts at the base of each flower and the four or five obovate 
outer sepals are of a reddish color, membranous and veiny ; calyx 
top-shaped, hairy, enclosing two carpels or nutlets ; odor slight, 
fragrant, and tea-like ; taste bitter, acrid, and nauseous. 

It contains a neutral active principle, kosin, a tasteless and an 
acid resin, and about 24 per cent, of tannin. 

Dose. — .1-4 drachms (4.0-16.0 Gm.). 

Official Preparation. 

Extractum Ctisso Fluidum— ExtrScti Cusso Fluidi— Fluid Extract of 
Cusso. — Dose, 1-4 fluidrachms (4.0-15.0 Cc). 

Kosin — Koussein (unofficial). — Origin. — The active principle from the flowers 
and unripe fruits of Hagenia Abyssinica (Bruce) Gmelin. 

Description and Properties. — An amorphous yellowish crystalline powder having a 
pungent bitter taste. Insoluble in water, but readily soluble in alcohol and in ether. 

Dose, 15-30 grains (1.0-2.0 Gm.), to be divided into four doses and taken at inter- 
vals of half an hour. 

Physiological Action and Therapeutics. — The action of kousso 
upon the digestive tract, under large doses, is similar to the action 
of aspidium. It is a reliable anthelmintic for all species of tape- 
worm. The fluid extract should be given in the form of an emul- 
sion, the patient having previously fasted, and the exhibition of the 
drug followed in a few hours by a large dose of castor oil. 

Granatum— Granati— Pomegranate. U. S. P. 

Origin. — The bark of the stem and root of Punica Granatum 
L., a shrub or small tree about 20 feet (6 M.) high, indigenous 
in Southwestern Asia from Northern India to Palestine. 



726 A TEXT-BOOK OF MATERIA MEDICA. 

Description and Properties. — In thin quills or fragments from 
2 to 4 inches (5 to 10 Cm.) long and from fa to ^ inch (1. to 3. 
Mm.) thick ; outer surface yellowish-gray, somewhat warty or 
longitudinally and reticulately ridged ; the stem-bark often partly 
covered with blackish lichens ; the thicker pieces of the root-bark 
more or less scaly externally ; inner surface smooth, finely striate, 
grayish-yellow; fracture short, granular, greenish-yellow, indis- 
tinctly radiate ; inodorous ; taste astringent, very slightly bitter. 

It contains as its active constituent a liquid alkaloid, pelletierine, 
with its three allied alkaloids, methyl-pelletierine ', pseudo-pelletierine, 
and iso-pelletierine, besides mannite and punico-tannic acid. 

Dose. — J-iJ drachms (2.0-6.0 Gm.). 

Unofficial Preparations. 

Pelletierine. — Origin. — An alkaloid derived from the root-bark of Punica gratia- 
turn L. 

Description and Properties. — A colorless liquid. Soluble in 20 parts of water and 
miscible in all proportions with alcohol. It forms crystalline salts with acids, the prin- 
cipal one being the tannate. 

There are also the sulphate, hydrobromate and hydrochlorate. 

Pelletierinae Tannas — Pelletierinae Tannatis — Pelletierine Tannate. — De- 
scription and Properties. — A yellowish, hygroscopic, odorless powder, with a pungent 
astringent taste. Soluble in 700 parts of water and in 80 parts of alcohol. 

Dose. — 1-5 grains (0.06-0.32 Gm.). 

Physiological Action and Therapeutics. — Locally pomegran- 
ate is astringent. In large doses it excites vomiting, acts as a 
purgative, paralyzes the motor nerves, but does not affect sensa- 
tion, and dilates the capillaries. 

Pomegranate and its alkaloid, pelletierine, are efficient anthel- 
mintics for tape-worm. 

Like other anthelmintics, the drug should be given on an empty 
stomach, and if the bowels are not freely moved by the remedy, an 
active cathartic should follow its administration. 

A decoction of the bark may be used, but, owing to the diffi- 
culty in obtaining the fresh drug, which alone possesses anthel- 
mintic properties, the tannate of pelletierine, which is always 
reliable, is usually administered. 

Kamala— Kamalae— Kamala. TI. S. P. 

(ROTTLERA.) 

Origin. — The glands and hairs from the capsules of Mallotus 
Philippinensis (Lamarck) Mueller Arg., a large shrub or small tree 



ANTHELMINTICS. 727 

growing wild in Australia, Eastern China, India, Southern Arabia, 
and Abyssinia. 

Description and Properties. — A granular, mobile, brick-red or 
brownish-red powder, inodorous and nearly tasteless, imparting a 
deep-red color to alkaline liquids, alcohol, ether, or chloroform, 
and a pale yellow tinge to boiling water. Under the microscope it 
is seen to consist of stellately arranged, colorless hairs, mixed with 
depressed-globular glands, containing numerous red, club-shaped 
vesicles. It contains a resinous coloring matter, rottlerin, and 
several resins. 

Dose. — 1-2 drachms (4.0-8.0 Gm.). 

Physiological Action and Therapeutics. — Kamala is a gastro- 
intestinal irritant and purgative, and an efficient anthelmintic against 
the Tcenia solium, as well as the Oxyuris vermicularis and the Ascaris 
lumbricoides. The drug should be taken suspended in syrup, and 
followed by a full dose of castor oil. 



Pepo— Peponis— Pumpkin Seed. U. S. P. 

Origin. — The seed of Cucurbita Pepo L., the common pumpkin, 
indigenous in tropical Asia and America, and cultivated through- 
out the temperate zones. 

Description and Properties. — About f inch (2 Cm.) long, 
broadly-ovate, flat, white or whitish, nearly smooth, with a shallow 
groove parallel to the edge ; containing a short, conical radicle and 
two flat cotyledons ; inodorous ; taste bland and oily. It contains 
an acrid resin, supposed to be the active principle, and from 30 to 
35 per cent, of a thick red fixed oil. 

Dose. — 1-3 ounces (32.0-94.0 Gm.). 

Physiological Action and Therapeutics. — Pumpkin seed ranks 
next to aspidium as a remedy for the destruction of tape-worm, 
and has the advantage of being free from any disagreeable taste or 
unpleasant action. For administration the fresh pumpkin seeds 
should be beaten into a paste with powdered sugar and diluted 
with milk or water to about 1 pint (473.17 Cc). Previous to its 
administration the patient should fast for twenty-four hours, when 
the bowels should be flushed out with a large saline purgative. 
A portion of the emulsion of pumpkin seed is then to be taken, 
preferably in the morning, and the balance taken in two doses at 
intervals of about two hours, the patient meanwhile remaining in 
bed to prevent, as far as possible, disturbance of the stomach. 



728 



A TEXT-BOOK OF MA TERIA MEDICA. 



Three or four hours after the last dose of the emulsion has been 
taken the patient should be given a full dose of castor oil. 



GROUP XVL— EMMENAGOGUES AND ECBOLICS. 

Emmenagogues are remedies which restore or increase the men- 
strual flow. They are divided, according to their action, into two 
classes. Those which act upon the uterine muscle or mucous 
membrane are said to be direct ; those which influence the uterus 
by affecting the general health of the body, or by altering the 
blood-supply of the parts, or by influencing the nervous system, 
are said to be indirect. 

The principal Direct Emmenagogues are — 



Ergot, 


Borax, 


Digitalis, 


Rue, 


Savine, 


Hydrastis, 


Quinine, 


Caulophyllum, 


Asafetida, 


Tansy, 


Myrrh, 


Apiol, 


Guaiac, 


Hedeoma. 


Cantharides, 




The Indirect Emmenagogues are- 




Iron and the Hematics, 


Cinnamon, 


Cod Liver Oil, 


Aloes. 


Strychnine, 




c Hot foot-bath. 




Baths \ Hot hip-bath. 




1 Mustard bath. 





Leeches (To genitals. 

I To thighs. 



C Baths. 
Mustards Poultices to thighs. 
I Stupes. 
Ecbolics or Oxytocics are remedies which act directly upon the 
uterine muscular fibers, inducing uterine contraction, and are chiefly 
used during or immediately after parturition to produce or increase 
uterine action. They are therefore contraindicated before parturi- 
tion, lest they induce abortion, although they are often used crimi- 
nally for this purpose. 

The exact manner in which ecbolics act is unknown, but it is 



EMMENAGOGUES AND ECBOLICS. 729 

supposed that they act directly by stimulating the uterine center 
in the cord or reflexly through uterine congestion. 

In small doses many of the ecbolics are emmenagogue, while 
many of the direct emmenagogues are ecbolic. 

The only justifiable uses for ecbolics are in parturition, with 
uterine inertia and unobstructed and well-dilated maternal parts, 
when it is desired to hasten the delivery of the child, or, second, 
to induce firm contraction of the uterus, and thus prevent or check 
uterine hemorrhage after the birth of the child. 
The principal Ecbolics are — 

Ergot, Oil of Rue, 

Ustilago, Borax, 

Hydrastis, Pilocarpine, 

Savine, Potassium Permanganate, 

Quinine, Strong Purgatives. 

Cotton Root Bark, 

Drugs which have not been considered elsewhere in the present 
work will now be described. 

SabTna— Sablnae— Savine. U. S. r. 

Origin. — The tops of Juniperus Sabina L., a small ever- 
green procumbent or erect shrub, distributed throughout the 
greater portion of Europe, Siberia, Canada, and the Northern 
United States. 

Description and Properties. — Short, thin, subquadrangular 
branchlets ; leaves rather dark green, in four rows, opposite, scale- 
like, ovate-lanceolate, more or less acute, appressed, imbricated, 
on the back with a shallow groove containing an oblong or round- 
ish gland ; odor peculiar, terebinthinate ; taste nauseous, resinous, 
and bitter. 

It contains 2 per cent, of a volatile oil, tannin, resin, gum, etc. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Official Preparation. 

Extr^ctum Sablnae Fluidum — Extraxti Sabinae Fluidi— Fluid Extract of 
Savine. — Dose, 5-15 minims (0.3-1.0 Cc). 

Oleum Sablnae— Olei Sablnae— Oil of Savine. 

r. s. p. 

Origin. — A volatile oil distilled from Savine. 

Description and Properties. — A colorless or yellowish liquid 



730 A TEXT-BOOK OF MATERIA MEDICA. 

having a peculiar terebinthinate odor and a 'pungent, bitterish, and 
camphoraceous taste. It becomes darker and thicker by age and 
exposure to the air. Soluble in an equal volume of alcohol. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Physiological Action and Therapeutics. — The action of savine 
depends on the presence of the volatile oil, and this oil differs in 
its local external effect from the oil of turpentine merely in that 
the oil of savine is more active. It occasions much irritation, vesi- 
cation, and even pustulation when applied to the skin. Taken 
internally in small doses, it produces a sensation of heat in the 
epigastrium, with flatulence and frequently nausea. Toxic doses 
excite violent gastro-enteritis. 

The drug stimulates the circulation, and later, under full me- 
dicinal doses, depresses it. It is rapidly absorbed, and is excreted 
by various channels, increasing the urinary and bronchial excre- 
tions. These excretions, as well as the sweat and breath, smell 
strongly of the drug. 

Savine is a decided irritant to the uterus and ovaries, inducing 
marked hyperemia of those organs, and promoting contractions of 
the pregnant uterus. 

Toxic doses produce symptoms similar to those occasioned by 
oil of turpentine — violent gastro-enteritis, suppressed or bloody 
urine, great depression, etc. The treatment in poisoning by oil of 
savine would be full doses of Epsom salt, demulcents, anodynes, 
and stimulants if necessary. 

Savine in the form of an ointment is used as a stimulant appli- 
cation to keep up the discharge from blisters. An alcoholic solu- 
tion of oil of savine, 5-30 minims (0.3-1.8 Cc.) to 1 ounce (30.0 
Cc), is used in alopecia pityroides. 

Oil of savine is a very efficient remedy in amenorrhea, and is 
also of benefit in certain cases of menorrhagia due to an enlarged 
and passively congested uterus. The hemorrhage following abor- 
tion is usually well controlled by this remedy. 

The powder or fluid extract may be given, but the oil is the 
most effective preparation, and may be prescribed in capsules, pills, 
or emulsion. It should be given cautiously. 

Ruta— Rutae— Rue. (Unofficial.) 

Origin. — The leaves of Ruta graveolens L., an herbaceous or 
sufifruticose perennial 2 or 3 feet (60 or 90 Cm.) high, indigenous 
in Southern Europe. 



EMMENAGOGUES AND ECBOLICS 731 

Description and Properties. — The leaves are ternate, the leaf- 
lets being obovate-oblong, yellowish-green, thickly dotted with 
minute, transparent oil-vesicles. They have a peculiar, strongly 
balsamic odor, and possess an aromatic, bitter, and acrid taste. 

The principal constituent of rue is a volatile oil. 

Dose. — 5-20 grains (0.3-1.3 Gm.). 

Oleum Rutae— Olei Rutae— Oil of Rue. (Unofficial.) 

Origin. — A volatile oil distilled from Ruta graveolens L. 

Description and Properties. — A colorless or greenish-yellow 
liquid with the peculiar odor of the plant, and a pungent, some- 
what acrid, bitterish taste. Soluble in an equal weight of alcohol. 

Dose. — 2-5 minims (0.13-0.3 Cc). 

Physiological Action and Therapeutics. — The action of oil 
of rue is analogous to that of oil of savine, though less powerful. 
It is used for the same purposes also, and has occasionally been 
employed in hysteria. 

The oil should be administered in capsules. 

Caulophyllum— Caulophylli— Caulophyllum. 
U. S. JP. 

(Blue Cohosh.) 

Origin. — The rhizome and roots of Caulophyllum Thalictroides 
(L.) Michaux, a smooth and glaucous perennial, found in rich 
woodlands from Canada south to Carolina and Kentucky. 

Description and Properties. — Rhizome of horizontal growth, 
about 4 inches (10 Cm.) long and about \ to f inch (6 to 10 Mm.) 
thick, bent; on the upper side with broad, concave stem-scars 
and short, knotty branches ; externally grayish-brown, internally 
whitish, tough, and woody. Roots numerous, matted, about 4 
inches (10 Cm.) long and -fa inch (1 Mm.) thick, rather tough; 
nearly inodorous ; taste sweetish, slightly bitter, and somewhat 
acrid. 

Caulophyllum contains an odorless, colorless, and tasteless alka- 
loid, caulophyllin, besides resins, tannin, starch, gum, etc. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Physiological Action and Therapeutics. — Blue cohosh is em- 
menagogue, antispasmodic, diuretic, and demulcent. It is quite an 
efficient remedy to increase the force of uterine contractions, and 
is of service in the treatment of spasmodic dysmenorrliea. 

It is usually given in the form of a decoction. 



732 A TEXT-BOOK OF MA TERIA MEDICA. 

Tanacetum— Tanaceti— Tansy. U. S. JP. 

Origin. — The leaves and tops of Tanacetum vulgare L., a 
perennial herb indigenous in Europe and Central Asia, and nat- 
uralized in many parts of North America. 

Description and Properties. — Leaves about 6 inches (15.24 
Cm.) long, bipinnatifid, the segments oblong, obtuse, serrate, or 
incised, smooth, dark green, and glandular; flower-heads corym- 
bose, with an imbricated involucre, a convex, naked receptacle, and 
numerous yellow tubular florets; odor strongly aromatic; taste 
pungent and bitter. 

It contains a volatile oil and a bitter principle, tanacetin, besides 
tannin, resin, etc. 

Dose. — 15-60 grains (1.0-4.0 Gm.), in infusion. 

Physiological Action and Therapeutics. — In moderate doses 
tansy acts as an aromatic bitter. Excessive amounts produce all 
the symptoms of an irritant narcotic — vomiting, purging, severe 
abdominal pain, loss of consciousness, convulsions, and great car- 
diac and respiratory weakness, death usually resulting from paral- 
ysis of respiration. 

The drug is regarded as an efficient remedy in amenorrhea, and 
is extensively employed in domestic practice in hysteria and colic, 
and topically for bruises, sprai?ts, muscular rheumatism, etc. 

It is used in the rural districts to promote or restore menstrua- 
tion, and occasionally is employed with criminal intent as an abor- 
tifacient, but usually with negative results. 

The drug may be given in the form of an infusion, 1 ounce to 
1 pint (32.0 Gm -473.17 Cc), of which 1 or 2 ounces (30.0 or 60.0 
Cc.) may be taken at a dose. 

The oil of tansy is occasionally prescribed in doses of 1-5 
minims (0.06-0.3 Cc). 

Petroselinum— Petroselini— Parsley. 

Origin. — The root of Petroselinum sativum (Hoffmann), Apium 
Petroselinum L., a plant indigenous in Southern Europe, and much 
cultivated for culinary purposes. 

Description and Properties. — The root is tapering, from 4 to 
8 inches (10-20 Cm.) long, about \ inch (12 Mm.) thick; exter- 
nally yellowish or light brown ; odor aromatic ; taste sweetish and 
aromatic. 

It contains a volatile oil and apiol, the chief constituent. 

Dose. — 30-60 grains (2.0-4.0 Gm.). 



EMMENAGOGUES AND ECBOLICS. 733 

Apiolum — Apioli — Apiol (Unofficial). — Origin. — A camphor obtained from the 
fruit of Petroselinum sativum Hoffmann. 

Description and Properties. — White needles, of a feeble, parsley odor. Insoluble 
in water, but freely soluble in alcohol and in ether. 
• Dose. — 10-15 g rams (0.6-1.0 Gm.). 

Physiological Action and Therapeutics. — The root is carmin- 
ative, laxative, and diuretic. Apiol is an active emmenagogue. 
Given in excessive doses, it occasions severe frontal headache, 
dizziness, and ringing in the ears. It causes a rapid rise of blood- 
pressure, due to increased cardiac action and stimulation of the 
vaso-motor centers. 

Apiol, or Chapoteaut's apioline, is usually prescribed, and is 
an efficient remedy in amenorrhea, dysmenorrhea, and as an anti- 
periodic in malarial affections. As an emmenagogue in cases of 
scanty or deficient menstruation apioline is very effective. 

The drug is best given in capsules, as prepared by Chapoteaut, 1 
one or two capsules being taken after meals three times a day. 

Hedeoma- Hedeomae— Hedeoma. U. S. JP. 

(Pennyroyal.) 

Origin. — The leaves and tops of Hedeoma pidegioides (L.) Per- 
soon, an annual herb indigenous in North America. 

Description and Properties. — Leaves opposite, short-petioled, 
about \ inch (12 Mm.) long, oblong-ovate, obscurely serrate, glan- 
dular beneath ; branches roundish-quadrangular, hairy ; flowers in 
small, axillary cymules, with a tubular-ovoid, bilabiate, and five- 
toothed calyx, and a pale-blue, spotted, bilabiate corolla, containing 
two sterile and two fertile exserted stamens ; odor strong, mint-like ; 
taste warm and pungent. Its virtues depend upon a volatile oil. 

Dose. — 15-60 grains (1.0-4.0 Gm.) in infusion. 

Oleum Hedeomae— Olei Hedeomae— Oil of Hede- 
oma. U. S. JP. 

(Oil of Pennyroyal.) 

Origin. — A volatile oil distilled from Hedeoma. 
Description and Properties. — A pale-yellowish, limpid liquid, 
having a characteristic, pungent, mint-like odor and taste. It should 

1 M. Chapoteaut has prepared from the alcoholic solution of a petrol-ethereal extract 
a thick reddish liquid, to which he has given the name Apioline. This substance he 
claims to be the true active principle, and it is dispensed in capsules containing 3 minims 
(0.18 Cc.) each. 



734 A TEXT-BOOK OF MA TERIA MEDICA. 

be kept in well-stoppered bottles, in a cool place, protected from 
light. 

Dose. — 2-10 minims (0.1-0.6 Cc). 

Physiological Action and Therapeutics. — Hedeoma is aro- 
matic, stimulant, carminative, and emmenagogue, while the oil is 
rubefacient if rubbed into the skin. 

The herb is given in the form of a hot infusion to bring on 
retarded or suspended menstruation and for the relief of flatulent 
colic, pharyngitis, bronchitis, etc., as well as to dissipate congestions 
of various parts. 

The oil of hedeoma is an active emmenagogue, and is used 
to increase the rubefacient effect of various embrocations. 



GROUP XVII.— ASTRINGENTS. 

Astringents are medicines which cause the contraction of living 
tissues, diminishing the amount of blood or other fluid in them, and 
reducing hemorrhage, or, through their constipating action, limiting 
the intestinal secretions as well as those from mucous membranes 
generally. 

They act chemically upon the tissues, and, when taken inter- 
nally, their influence is similar to that of tonics, invigorating the 
various structures of the body, their principal use being, in cases 
of relaxed conditions of the muscles and fibers or of the mucous 
membranes characterized by excessive secretion. 

Astringents are more or less irritating, and should therefore not 
be employed, as a rule, in acute inflammatory conditions. There 
are, however, four exceptions — lead acetate or subacetate, bismuth 
subnitrate or subcarbonate, cerium oxalate, and silver nitrate — 
which are sedative astringents and would be indicated in acute 
inflammatory states. 

Astringents vary in the intensity of their action, their strength 
being directly proportionate to the precipitation of albumin and the 
acid ion of the precipitant. 

The chlorides of the heavy metals are usually soluble, and are 
generally the more caustic, as, for instance, zinc chloride, mercuric 
chloride (corrosive sublimate), etc. Should a chloride be insoluble 
in water, it will not act as a caustic — as, for example, the insoluble, 
and consequently inert, silver chloride. 

Certain drugs which in a concentrated state are caustic are, if 
sufficiently diluted, astringent, as is the case with sulphuric acid. 



ASTRINGENTS. 735 

An astringent drug employed to check hemorrhage is called a 
styptic, the subsulphate of iron being extensively used as such. 

Astringents differ in some respects from other groups of medi- 
cines, in that they do not, as a rule, assist one another by combi- 
nation. They are divisible into — (1) Vegetable astringents; (2) 
mineral astringents. The vegetable astringents mentioned in this 
group, beginning with the type, are — 

Tannic Acid, Kino, Rhus Glabra, 

Gallic Acid, Krameria, Rosa Gallica 

Galla, Hematoxylon, Rubus. 

Quercus Alba, Hamamelis, 

Catechu, Geranium, 

The astringent action in most of them is due to tannin com- 
pounds. 

The mineral astringents, beginning with the type, are — 
Lead, Silver, Bismuth, 

Zinc, Alum, Cerium Oxalate. 

Copper, 

Certain salts of iron are powerfully astringent, although classed 
with iron under the Restoratives. Diluted sulphuric and nitric acids 
also possess marked astringent properties. (See Mineral Acids.) 

Antagonists and Incompatibles. — The vegetable astringents 
are incompatible with the salts of iron (ferric and ferrous), and also 
with the salts of lead, silver, antimony, and copper ; with the alka- 
loids, the glucosids, and gelatin ; and with the alkalies and mineral 
acids and emulsions. Spirit of nitrous ether is incompatible with 
gallic acid. 

Synergists. — Tonics and bitters, and also agents increasing 
waste, favor the action of vegetable astringents. 

VEGETABLE ASTRINGENTS. 

Acidum Tannicum— Acidi Tannici— Tannic Acid. 

U. S. J>. 

Origin. — An organic acid obtained from Nutgall. 

Description and Properties. — A light-yellowish, amorphous 
powder, usually cohering in the form of glistening scales or spongy 
masses ; odorless or with a faint characteristic odor and a strongly 
astringent taste ; gradually turning darker when exposed to air and 
light. Soluble in about 1 part of water and in 0.6 part of alcohol ; 



736 A TEXT-BOOK OF MATERIA MEDICA. 

very soluble in boiling water and in boiling alcohol ; also soluble 
in about I part of glycerin with the assistance of a moderate heat ; 
freely soluble in diluted alcohol and sparingly in absolute alcohol ; 
almost insoluble in absolute ether, chloroform, benzol, or benzin. 
Dose. — 1-20 grains (0.06-1.2 Gm.). 

Official Preparations. 

Collodium Stypticum — Collodii Styptici — Styptic Collodion. — Used exter- 
nally and locally. (Tannic Acid, 20; Alcohol, 5; Ether, 25; Collodion, to 100.) 

Glyceritum Acidi Tannici — Glyceriti Acidi Tannici — Glycerite of Tannic 
Acid. — Used externally and locally. (Tannic Acid, 20; Glycerin, 80.) 

Trochisci Acidi Tannici— Trochiscos (ace.) Acidi Tannici— Troches of 
Tannic Acid. — Dose, 1 to 3 troches. 

UnguSntum Acidi Tannici — UnguSnti Acidi Tannici — Ointment of Tannic 
Acid. —Used externally and locally. (Tannic Acid, 20; Benzoated Lard, 80.) 

Physiological Action. — Externally. — Tannic acid has little if 
any effect upon the unbroken skin. Upon raw surfaces, however, 
it acts as a powerful astringent, contracting the tissues and coagu- 
lating the albumin. Urticaria and erythema sometimes follow its 
use. 

Internally. — Digestive System. — By coagulating the albumins 
tannic acid imparts a dryness to the mouth, accompanied by a sen- 
sation of puckering. It partially paralyzes the sensory nerve- 
endings, thus blunting the sense of taste. Large doses produce 
vomiting by an irritant action, while diarrhea, followed by consti- 
pation, may be present. 

By its action on the stomach pepsin is precipitated, albumin co- 
agulated, and the secretion of gastric juice diminished, all of which 
actions tend to impair the digestive function. There is a partial 
conversion of the tannic acid into gallic and pyrogallic acids. To 
facilitate absorption there must be a preliminary conversion of 
tannic into gallic acid, and this reaction takes place in the intestine. 
A diminution of peristalsis is followed by constipation. 

Circulatory System. — Its astringent property makes tannic acid 
a valuable hemostatic. It arrests hemorrhage by contracting the 
blood-vessels. The blood absorbs it as gallic acid, and is not 
affectod by it. 

Nervous System. — No special effect has been observed. 

Absorption and Elimination. — Being absorbed as gallic acid, the 
kidneys eliminate it in that form. A doubtful action ascribed to it 
by some authorities is that of diminishing albuminuria. 



ASTRINGENTS. 7 37 

Uterus. — No special influence other than arresting hemorrhage 
has been noted. 

Untoward Action. — A dose of 3 grains (0.2 Gm.) may cause 
pain in the stomach and intestines. Following such a dose, there 
may be coating of the tongue, thirst, eructation of gas, and tenes- 
mus. A tendency to hemorrhoidal congestion is enhanced. 

Therapeutics. — Externally and Locally. — Tannic acid is a val- 
uable application for bed-sores and ulcers. Its astringent property 
is of use in cases of intertrigo, impetigo, sycosis, sore nipples, and 
eczema of the chronic, desquamating variety. It is beneficial in 
hyperidrosis of the hands and feet, of the axillce and genitals. A 
solution of the acid has been found of advantage in erysipelas and 
lymphangitis. 

The glycerite of tannin, applied locally in cases of otorrhea 
and ozena as sequelae of scarlet fever or measles, is of great benefit. 
The same preparation or a powder may be used in stomatitis, ton- 
sillitis, and pharyngitis, as well as in cases of spongy or idcerous 
gums. The lozenges are beneficial in whooping cougli. Sup- 
positories of tannic acid are employed for hemorrhoids, fissure, 
prolapse, and rectal ulcers. 

An aqueous solution of tannic acid is very useful in leucor- 
rhea. The glycerite and iodoform tannin are excellent agents in 
inflammation of the cervix uteri. Tannic acid also dispels the odor 
and allays the discharges in carcinoma uteri, being applied as a 
vaginal douche. It is useful as a lotion in herpes and alopecia cir- 
cumscripta. Injection of the acid or insufflation of the powder into 
the urethra is of some value in gonorrhea. In hemoptysis an aque- 
ous solution (5-10 grains to the ounce of water) may be used as 
a spray. In acute dysentery much benefit may be derived from 
an enema of 10 grains of tannin added to a 4 per cent, solution of 
boric acid. It lessens pain and tenesmus and controls hemorrhage. 

Internally. — For other than local action gallic is preferable to 
tannic acid, the latter not being absorbable. Tannic acid is styptic 
in intestinal hemorrhage and is valuable in treatment of diarrhea. 
It forms tannates when given as an antidote for poisoning by alka- 
loids and tartar emetic. Since these tannates are more or less 
soluble, however, some drug should be given as a purgative. 

Contraindications. — From comparative absorbability of tannic 
and gallic acids the former is preferable for local, the latter for 
systemic, effects. 

Administration. — For hematemesis powders of 10-20 grains 
47 



738 A TEXT-BOOK OF MATERIA MEDICA. 

are given. For effect upon the intestines it should be administered 
in pills, 3-5 grains, or it may be dissolved in the stomach. Locally 
it may be applied as a solution, glycerite, powder, suppository, or 
an ointment. Styptic collodion is a protection to lacerated or 
incised wounds. 

Organic Combinations of Tannin.— -Because of its irritating prop- 
erties in the gastro-intestinal canal, tannic acid has been largely 
supplanted by a number of organic combinations. Among these 
are tannalbin, tannigen, tannoform, tannon (tannopin), and tan- 
nocol. 

Tannalbin. — This is a compound of tannin and albumin, heated 
to 120 F. It is obtained as a red-brown powder, and is decom- 
posed by the alkaline secretions of the intestinal canal and not by 
the gastric juice. It is one of the best of these newer compounds 
in the treatment of intestinal diarrhea if such diarrheas call for 
astringent action. The dose of tannalbin is from 45-150 grains 
(3-10 Gm.) for adults, children in proportion. 

Tannigen. — This is a yellowish-gray powder — an acetic ester 
of tannic acid. It is odorless and tasteless, hygroscopic, insol- 
uble in water, and slightly soluble in ether and alcohol. It 
acts best in the alkaline secretions, and is not acted on, or but 
slightly (Rost), by the gastric secretions. It is useful as an intes- 
tinal astringent in chronic diarrheas in about the same dosage as 
tannalbin. 

Tannoform. — This is a product of condensation formed by the 
action of formaldehyd on gallotannic acids. It is a pale rose- 
colored powder, insoluble in water and soluble in alkaline solutions. 
It is valuable in diarrheas associated with much fermentation, and is 
also used as a topical application (as 10 per cent, ointment) in 
ozena, burns, hyperidrosis, pruritus, and hemorrhoids. Its dose 
internally is from 5-8 grains (0.25-0.5 Gm.). A number of tanno- 
forms may be formed from the vegetable astringents, such as rubus, 
juglans, rhatany, catechu, quercus, etc. 

Tannon, also called tannopin, is a combination of urotropin and 
tannin. It is a light-brown powder, insoluble in water and soluble 
in weak alkaline fluids. It has been recommended in diarrhea in 
15-grain doses (1 Gm.). 

Tannocol. — This combination of tannic acid and gelatin is 
practically identical with tannalbin. 



ASTRINGENTS. 739 

Acidum Gallicum— Acidi G&llici— Gallic Acid. 
U. S. JP. 

Origin. — An organic acid usually prepared from Tannic Acid. 

Description and Properties. — White or pale fawn-colored, 
silky, interlaced needles or triclinic prisms ; odorless, having an 
astringent or slightly acidulous taste ; permanent in the air. Sol- 
uble in 100 parts of water and in 5 parts of alcohol. 

Dose. — 5-20 grains (0.3-1.2 Gm.). 

Physiological Action. — Gallic acid resembles tannic acid in 
its action, but does not coagulate albumin, and therefore does not 
possess the local influence of the latter. It is eliminated by the 
kidneys as gallic acid. 

Therapeutics. — Externally and Locally. — Gallic acid is seldom 
used externally. Locally, tannic acid is preferable, but gallic acid 
is effectual applied as a glycerite, 1 drachm- 1 ounce (4.0-32.0 Gm.), 
in cases of tonsillitis and pharyngitis. Gallic acid and stramonium 
ointment in equal parts form an unguent for hemorrhoids. In 
alcoholic solution it is applied to the membrane of diphtheria. 

Internally. — Gallic acid is chiefly serviceable in hemorrhage from 
the stomach, intestines, lungs, and kidneys, It is employed in men- 
orrhagia, but ergot is better. It reduces albumin in some forms 
of Bright' s disease, and is useful in checking excessive sweating and 
bronchorrhea. In chroiiic phthisis it relieves the night-sweats and 
reduces profuse expectoration. Cystitis, dysentery, and chronic diar- 
rhea are benefited by its use. It checks suppuration and stays the 
progress of pyelitis and pyelo-nephritis. Used in conjunction with 
opium, it has been found beneficial in diabetes insipidus. 

Pyrogallic acid is of use in acne, but produces a discoloration 
of the skin. 

Eugallol and Lenigallol, acetates of pyrogallic acid, have 
been advised as substitutes of pyrogallic acid in psoriasis and acute 
and chronic eczemas. 

Pyrogallol, 2 grains (.12 Gm.), is used in internal hemorrhage. 
As an ointment, 1 drachm- 1 ounce (4.0-32.0 Gm.), it is palliative 
in psoriasis, and it is also beneficial in lupus and epithelioma. 

Gallanol, the analid of gallic acid, is a bactericide, and is use- 
ful in psoriasis in the form of a powder or in an ointment (1 to 30). 
It is also used in alcoholic solutions of 10 per cent, strength. It 
relieves the pruritus of chronic eczema, \nfavus and tricophytosis 
a mixture is used consisting of gallanol 10 parts, ammonia 1 part, 
and alcohol 50 parts. 



740 A TEXT-BOOK OF MA TERIA MEDICA. 

Gallicine, methyl ether of gallic acid, applied in finely divided 
form with a brush, is of benefit in. keratitis and conjunctivitis, as 
well as in eczema of the eyelids. 

Administration. — Gallic acid is not to be combined with iron. 
It is administered in powder or pill form. The glycerite and the 
ointment are used locally. 

Galla-Gallse-Nutgall. U. S. P. 

Origin. — An excrescence on Quercus Lusitanica Lamarck, caused 
by the punctures and deposited ova of Cynips gallce tinctorice 
Olivier. 

Quercus Lusitanica is a small tree, or oftener a shrub, 4 to 6 
feet (1.2- 1. 8 M.) high, indigenous in the basin of the Mediter- 
ranean. 

Description and Properties. — Nutgalls are subglobular, about 
1 inch (25 Mm.) in diameter, more or less tuberculated above, 
otherwise smooth, heavy, hard; often with a circular hole near 
the middle communicating with the central cavity containing either 
the partly developed insect or pulverulent remains of it; inodor- 
ous ; taste strongly astringent. 

Galla in substance is seldom given internally. 

Official Preparations. 

Tin»tura Gallae— Tincturae Gallae — Tincture of Nutgall.— Dose, 1 to 2 fluid- 
drachms (4.0-8.0 Gm.). 

Unguentum Galla — Unguenti G&llse — Ointment of Nutgall. — Used exter- 
nally. 

Physiological Action. — Its action is that of tannic acid, which 
is derived from galls. 

Therapeutics. — Externally and Locally. — Galla, in combination 
with stramonium liniment or 1 drachm (4.0 Gm.) of powdered 
opium to each ounce (32.0 Gm.) of nutgall ointment, is an excellent 
application for external hemorrhoids. For eczema of the scalp, 
herpes, fissured nipples, indolent ulcers, and chilblains nutgall oint- 
ment has proved beneficial, as well as for alopecia circumscripta 
and rectal prolapse. One part of powdered galls to seven or eight 
of vaseline is a moat excellent application for lessening the cica- 
tricial contraction following extensive burns. Galla is used little 
locally, but is recommended as a gargle and wash, being applied 
to the relaxed mucous membranes of the mouth, vagina, and 
rectum. 



ASTRINGENTS. 741 

Internally. — Tannic and gallic acids are preferable in severe 
diarrhea and dysentery, an infusion or decoction being used as an 
enema. 

Administration. — Galls are used mostly in the form of an 
infusion or ointment. The tincture is seldom employed. 

Qugrcus Alba— Quercus Albae— White Oak. 
U. S. 2>. 

Origin. — The bark of Quercus alba L. The oaks are shrubs 
or trees growing chiefly in the temperate zone, often forming exten- 
sive forests. The white oak is a stately tree, 60 to 80 feet (18-24 
M.) high, found from Canada to Florida and west to Wisconsin 
and Eastern Texas. 

Description and Properties. — In nearly flat pieces deprived of 
the corky layer, about \ inch (5 Mm.), pale brown ; inner surface 
with short, sharp, longitudinal ridges ; tough and of a coarse, 
fibrous fracture, a faint, tan-like odor, and a strongly astringent 
taste. As found in the shops, it is usually an irregularly coarse 
fibrous powder, which does not tinge the saliva yellow. 

Dose. — Seldom given in substance. A decoction is sometimes 
given internally, but the chief use of the drug is for external or 
local application. 

Physiological Action. — The general action is that of tannic 
acid. 

Therapeutics. — Externally and Locally. — It is used for chapped 
nipples, gangrene, idcers, and dermatitis venenata. It is of value 
as an ointment in hemorrhoids, prolapsus ani, anal fissure, and leu- 
corrhea. The drug is also serviceable in relaxed uvula and as a 
tooth-powder. It stains the linen, however, which somewhat limits 
its use. Pessaries made of the bark have been used to check 
uterine hemorrhage. For hernia the concentrated fluid extract is 
injected into the tissues for the purpose of exciting inflammation 
and consequent contraction of the hernial ring. 

Internally. — It reduces bronchial discharge, hemoptysis, serous 
diarrhea, and dysentery. 

Administration. — Externally it is used as a poultice — chiefly 
in the form of the powdered bark. The decoction is employed 
almost exclusively as an injection and for internal administration. 
The laity were formerly wont to roast the acorns and chew them, 
or grate them and mix the gratings with cocoa or chocolate, 
believing them to be a cure for diarrhea as well as for flatulent 
dyspepsia and scrofula. 



742 A TEXT-BOOK OF MA TERIA MEDICA. 

Catechu— Catechu— Catechu. IT. S. jP. 

Origin. — An extract prepared from the wood of Acacia catechu 
(Linn, fil.) Willd., a tree 30 to 40 feet (9-12 M.) high, indigenous 
in the East Indies and Ceylon. 

Description and Properties. — Occurring in irregular masses, 
containing fragments of leaves ; dark-brown, brittle, somewhat 
porous and glossy when freshly broken. It is nearly inodorous 
and has a strongly astringent and sweetish taste. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Official Preparations. 

Tinctura C5techu Compbsita — Tincturae Catechu Comp5sitae — Compound 
Tincture of Catechu. — Dose, \-2 fluidrachms (2.0-8.0 Cc). (Catechu, 100 ; Cassia 
Cinnamon, 50; by maceration and percolation with Diluted Alcohol to 1000.) 

Trochisci C&techu — Trochiscos (ace.) C&techu — Troches of Catechu. — 

Dose, 1 to 6 troches. (Each troche contains I grain (0.06 Gm.) of catechu.) 

Physiological Action. — Catechu does not differ in its action 
from tannic acid. It is to be preferred to kino, however, since its 
operation is more energetic. 

Therapeutics. — Externally and Locally. — Though used but 
little externally, it is a very efficient remedy for ulcerated nipples 
and chronic ulcers, the form employed being that of a lotion, used 
either alone or in combination with copper sulphate or alum. 
Catechu is of service in constringing relaxed tissues, and is used 
as a mouth-wash in spongy gums, ptyalism, and relaxation of the 
uvula. It is also of use as a gargle in pharyngitis and chronic sore 
throat of public speakers and users of tobacco. In gonorrhea and 
leucorrhea an injection of 2-3 drachms (8.0-12.0 Gm.) of the 
tincture in 5-6 ounces (1 60.0-192.0 Gm.) of water is beneficial. 

Catechu has been used by persons suffering from pyrosis. It is 
claimed that chewing a small pellet of the drug diminishes the 
coating of mucus on the mucous membrane of the stomach. It 
is applied to aphtha in stomatitis. 

Internally. — Its prevailing use is in chronic serous diarrheas, 
but the administration must be preceded by a saline purge in 
order to secure the fullest effect. 

Administration. — The troche is best used in chronic pharyn- 
gitis and relaxed buccal mucous membranes, or a piece of the 
drug may be chewed with beneficial results. For diarrhea the 
compound tincture, with a little morphine or the official chalk 
mixture, is the best form for use. 



ASTRINGENTS. 743 

Kino— Kino— Kino. U. S. P. 

Origin. — The inspissated juice of Pterocarpus marsupiarium 
Roxburgh, a tree (called buja in Bengal) 60 to 80 feet (18-24 M.) 
high, indigenous in India and Ceylon. 

Description and Properties. — Small, angular, dark brownish- 
red and transparent; inodorous, very astringent and sweetish, 
coloring the saliva deep red. Soluble in alcohol, nearly insoluble 
in ether, and only slightly soluble in cold water. 

Dose. — 10-20 grains (0.6-1.2 Gm.). 

Official Preparation. 

Tinctura Kino — Tincturse Kino — Tincture of Kino. — Dose, \-i fluidrachms 
(1.0-8.0 Cc). 

Physiological Action. — Its action is similar to that of tannic 
acid. It colors the saliva red. . 

Therapeutics. — Externally and Locally. — Kino is an efficient 
dressing for flabby, indolent ulcers, acting as a stimulant. Yet the 
other astringents deserve precedence. As a gargle in pharyngitis 
and relaxed uvula kino is valuable, but, owing to its disagreeable 
taste, krameria is to be preferred. Owing to its speedy action, it 
checks the hemorrhage in epistaxis where other astringents fail. 
In leucorrhea and gonorrhea an infusion or injection is serviceable. 

Internally. — In the polyuria of diabetes, in menorrhagia, the 
sweating of phthisis, and pyrosis it has been used to some advan- 
tage ; also in dysentery and chronic diarrheas with profuse serous 
discharges. It is less irritating than the other astringents. 

Administration. — The powder is used as an insufflation in 
epistaxis, and is dusted on ulcers. In diarrhea it is best to use kino 
in combination with opium or chalk mixture. The tincture is used 
internally. 

Krameria— Krameriae— Krameria. U. S. JP. 

(RlIATANY.) 

Origin. — The root of Krameria tria?idra Ruiz et Pavon, and of 
Krameria ixina L., a low shrub with spreading branches, native to 
Bolivia and Peru, growing in sandy localities in the mountains at 
an altitude of 3000 to 8000 feet (900-2440 M.). 

Description and Properties. — From 1 to 1^ inches (25-38 
Mm.) thick, knotty and several-headed above, branched below, the 
branches long; bark smooth, or in the thinner pieces scaly, deep 



744 A TEXT-BOOK OF MATERIA MEDICA. 

rust-brown, 2 * 5 ^ 2 inch (1-2 Mm.) thick, very astringent, inodor- 
ous; wood pale, brownish-red, tough, with fine medullary rays, 
nearly tasteless. The root of Krameida ixina (Savanilla rhatany) is 
less knotty and slenderer, and has a dark purplish-brown bark 
about \ inch (3 Mm.) thick. 

Dose. — 8-30 grains (0.5-2.0 Gm.). 

Official Preparations. 

Extralctum Krameriae — Extratcti Krameriae — Extract of Krameria. — Dose, 
5-10 grains (0.3-0.6 Gm.). 

Extr3ctum Krameriae Fluidum — ExtrScti Krameriae Fluidi — Fluid Extract 
of Krameria. — Dose, 5-30 minims (0.3-2.0 Cc). 

Tinctura Krameriae — Tincturae Krameriae — Tincture of Krameria. — Dose, 
\-i drachms (2.0-8.0 Cc). 

TrocMsci Krameriae — Trochlscos (ace.) Krameriae — Troches of Krameria. 
— Dose, 1 to 5 troches. (Each troche contains I grain (0.06 Gm.). 

Syrupus Krameriae — Syrupi Krameriae — Syrup of Krameria. — Dose, J-4 
fluidrachms (2.0-16.0 Cc). 

Physiological Action. — The action of krameria is identical with 
that of tannic acid. 

Therapeutics. — Externally and Locally. — Its value as a topical 
application is of little consequence, but it has served satisfactorily 
as an ointment for hemorrhoids. It is used as an infusion or injec- 
tion of the diluted tincture or fluid extract in leucorrhea, gleet, and 
especially in anal fissure, for which it has been highly recom- 
mended, since it checks the accumulation of feces in the rectum by 
constricting its walls, rendering defecation less painful and prevent- 
ing the formation of ulcers. The powder is used in epistaxis and 
rectal bleeding, also in prolapsus ani and ozena of a non-specific 
nature. It is used extensively in the preparation of tooth-powders, 
being especially beneficial where the gums display a tendency to 
bleed readily. A mouth-wash and gargle are used in ptyalism, 
spongy gums, pharyngitis, and relaxation of the uvula. 

Internally. — Krameria has gained a wide reputation for allaying 
habitual, but not profuse, uterine hemorrhage. It is a good tonic for 
debilitated patients. It is also used in chronic diarrhea and dysen- 
tery and in incontinence of urine. 

Administration. — The powder is used in the nose and rectum 
either by insufflation or by means of a pledget of cotton. As an 
injection and enema the fluid extract is used. In fissure of the 
anus the rectum must be emptied first by an enema ; then a solu- 
tion of the extract, I drachm (4.0 Gm.) to 1 ounce (30.0 Cc.) of 
water, is emptied into the bowel and allowed to run out, repeating 



ASTRINGENTS. 745 

the process several times. This procedure is very painful at first, 
but as the fissure gradually heals the operation will cause the 
patient little if any pain. Keep the bowels open with a mild 
saline laxative. The success attending the operation warrants any 
discomfort which the patient may experience. The nasal douche 
is best in ozena, followed by an insufflation of the powder. 

Haematoxylon— Haematoxyli— Haematoxylon. 

U. S. JP. 

(Logwood.) 

Origin. — The heart-wood of Hcematoxylon Campechianum L., a 
tree 30 to 40 feet (9-12 M.) high, indigenous on the shores of the 
Gulf of Campeachy and in certain parts of South America. 

Description and Properties. — Heavy, hard, externally pur- 
plish-black, internally brownish-red, marked with concentric cir- 
cles, splitting irregularly; odor faint, agreeable, taste sweetish, 
astringent. When chewed it colors the saliva dark pink. 

Only the preparations of Haematoxylon are used internally. 

Official Preparation. 

Extractum Haemat6xyli — Extr^cti HasmatSxyli — Extract of Haematoxy- 
lon. — Dose, 5-15 grains (0.3-1.0 Gm.). 

Physiological Action. — Its astringent properties are due to the 
tannin which haematoxylon contains. 

Therapeutics. — Externally and Locally. — It is a valuable anti- 
septic, as well as a healing application in gangrene and foul- 
smelling sores. It is also beneficial as an injection in leucorrhea. 

Internally. — Haematoxylon has a very agreeable, sweetish taste ; 
hence it is well taken by children. It is of marked benefit in in- 
fantile diarrhea, but has the disadvantage of coloring the dis- 
charges and diaper blood-red or purplish blue, causing much alarm 
to the mother. The urine is also colored. It arrests internal 
hemorrhage and sweating, and is also used in dysentery, tuberculous 
diarrhea, and atonic dyspepsia. Some authorities claim that 
haematoxylon causes phlebitis. 

Administration. — In diarrhea a decoction with a little aromatic 
sulphuric acid is the best preparation. To it may be added a little 
syrup of ginger and camphorated tincture of opium. The decoc- 
tion is, in fact, the best preparation to use. 



74^ A TEXT-BOOK OF MATERIA MEDIC A. 

Hamamelis— Hamamelidis— Hamamelis. V. S. P. 

(Witch-hazel.) 

Origin. — The leaves of Hamamelis Virginica L., a shrub 6 to 
io feet (1.8-3.0 M.) high, growing in damp woods and thickets in 
Canada and the United States. 

Description and Properties. — Short-petiolate, about 4 inches 
(10 Cm.) long, obovate or oval, slightly heart-shaped and oblique 
at the base, sinuate-toothed, thickish, nearly smooth, inodorous ; 
taste astringent and bitter. 

Official Preparation. 

Extr&ctum HamamSlidis Fluidum — Extr&cti Hamam&lidis Fluidi — Fluid 
Extract of Hamamelis. — Dose, y z -2. fluidrachms (2.0-8.0 Cc). 

Physiological Action. — The action of tannic acid is also that 
of hamamelis, save that the latter has a somewhat different influ- 
ence upon the circulation. 

Circulatory System. — Hamamelis acts on the muscular fibers of 
the veins, the modus operandi, however, not being satisfactorily 
determined. Large doses produce severe throbbing headache. 

Therapeutics. — Externally and Locally. — For sprains and bruises 
hamamelis is a favorite application, although some authorities re- 
gard it merely as a placebo. Locally, the fluid extract, with the 
addition of one-third its volume of glycerin, has been used in 
urticaria, rhus-poisoning, and phlegmasia do lens. Owing to its 
marked sedative properties, hamamelis ointment is extremely 
beneficial in varicose ulcers, eczema, herpes, seborrhea, and acne 
rosacea, as well as in checking excessive secretions. It is also 
efficient in carbuncle, freckles, hyperidrosis, lupus erythematosus, 
burns, and frost-bites. 

The local action of the drug is important. The distilled 
extract, diluted with alcohol or water, is applied to inflamed gums, 
the nasal mucous membrane after removal oi-polypi, and in pharyn- 
gitis as a spray. As a suppository or applied by means of a piece 
of cotton or wool soaked with the fluid extract, hamamelis affords 
a most grateful relief in bleeding piles, especially the internal vari- 
ety. In cystitis and hemorrhage from the bladder an injection of 
the diluted fluid extract or distilled extract is very valuable, 
besides being a most reliable topical application in capillary hemor- 
rhage from wounds, epistaxis, and bleeding after extraction of teeth. 
The ointment is used in rectal fissures and idcers, and the lotion 



ASTRINGENTS. 747 

has been employed to some extent in chronic rheumatism, since 
it relieves the pain and stiffness in the muscles and joints. The 
decoction, with a little boric acid and a 1 per cent, solution of 
creasote, has been recommended as a gonorrheal injection. 

Administration. — The best preparation, both for internal and 
external use, is the distilled extract, although it is not official. The 
ointment and lotion are used externally, and the fluid extract 
internally. The preparations of hamamelis to be found in drug- 
stores are unreliable unless they be perfectly fresh. 

Geranium— Geranii— Geranium. IT. S. I*. 

(Cranesbill.) 

Origin. — The rhizome of Geranium maculatum L., a perennial 
herb with a stem 2 to 3 feet (30-60 Cm.) high, very common in 
Canada and the United States westward as far as Kansas. 

Description and Properties. — Growth horizontal, cylindrical, 
2 to 3 inches (5-7 Cm.) long and about \ inch (1 Cm.) thick; 
rather sharply tuberculated, longitudinally wrinkled, dark brown ; 
bark thin ; wood-wedges yellowish, small, forming a circle near the 
cambium line ; medullary rays broad, central pith large ; roots 
thin, fragile, inodorous ; taste strongly astringent. 

Dose. — 20-40 grains (1.2-2.40 Gm.). 

Official Preparation. 

Extr&ctum Geranii Fluidum — Extr&cti Geranii Fluidi — Fluid Extract of 
Geranium. — Dose, 20-40 minims (1.2-2.40 Cc). 

Physiological Action. — The action of geranium corresponds 
with that of tannic acid. 

Therapeutics. — Externally and Locally. — Geranium is not used 
externally. Its local action is varied. It is serviceable as an 
astringent gargle in sore throat ; as a mouth-wash in aphthous 
stomatitis ; in relaxed conditions of the rectum, vagina, and throat; 
in buccal ulcer, metrorrhagia, and anal fissure ; in prolapsus ani and 
epistaxis. It has also proved valuable as an injection in leucorrhea, 
gonorrhea, and gleet. 

Internally. — Owing to its agreeable taste, it is useful in infantile 
diarrhea and for persons having weak stomachs. In the early 
stages of phthisis it is very beneficial, as it reduces the fever and 
pulse-rate, at the same time checking the night-sweats, cough, 
expectoration, and hemoptysis. Under it the patient's appetite im- 
proves and he gains in weight. 



748 A TEXT-BOOK OF MATERIA MEDIC A. 

Administration. — Locally, the powdered root and fluid extracts 
are used, but the fluid extract diluted with water is preferable. 
For an injection a decoction, I ounce (32.0 Gm.) to 1-2 pints 
(5 1 2.0-1024.0 Gm.) of water, is used," and the decoction in milk 
is of service in infantile diarrhea. Prof. Johnson claims that gera- 
nium contains mucilaginous material which, acting as a demulcent, 
makes the decoction a much more desirable preparation than a 
simple solution of tannin. 

Rhus Glabra— Rhois Glabrae— Rhus Glabra. 77. S. JP. 

(Sumach.) 

Origin. — The fruit of Rhus glabra L., a shrub or surTruticose 
plant about 12 feet (3.6 M.) high, growing in rocky or barren soil 
in North America. 

Description and Properties. — Subglobular, about \ inch (3 
Mm.) in diameter, drupaceous, crimson, densely hairy, containing 
a roundish-oblong, smooth putamen ; inodorous ; taste acidulous. 

Dose. — The preparations only are used internally. 

Official Preparation. 

Extractum Rhois Glabrae Fluidum — Extracti Rhois Glabrae Fluidi — Fluid 
Extract of Rhus Glabra. — Dose, \-\ fluidrachm (1.0-4.0 Cc). 

Allied Species. 
Rhiis AromStica — Rhois Aromaiticae — Sweet Sumach. 

Unofficial Preparation. 

Extractum Rhois Arom&ticae Fluidum — Extracti Rhois Arom^ticae Fluidi 
—Fluid Extract of Rhus Aromatica. — Dose, 5 minims-i fluidrachm (0.3-4.0 Cc). 

Physiological Action. — The action of Rhus glabra resembles 
that of tannic acid. 

Therapeutics. — Externally and Locally. — An infusion or the 
fluid extract is used as a topical application for ulcers and" in- 
flamed wounds. The infusion is an excellent mouth-wash in 
spongy gums, ptyalism, pharyngitis, aphthous stomatitis, and tonsil- 
litis. It can be used alone, but is much more efficient when com- 
bined with potassium chlorate and glycerin, adding a little menthol, 
2-3 grains (.12-20 Gm.), to make the mixture more agreeable. It 
is also of service as an injection in leucorrhea. 

Internally. — Rhus glabra acts well in staying incontinence of 
urine and hematuria. A dose of 10-30 drops of the fluid extract, 



ASTRINGENTS. 749 

taken two or three times daily, has produced complete temporary 
suspension of nocturnal eneuresis of children, as well as senile 
eneuresis. 

Administration. — The fluid extract is used exclusively. 

Rosa Gallica— Rosae Gallicae— Red Rose. U. S. r. 

Origin. — The petals of Rosa gallica L., collected before ex- 
panding. 

Description and Properties. — Usually occurring in small cones 
consisting of numerous imbricated, roundish, retuse, deep purple- 
colored, yellow-clawed petals, having a roseate odor and a bitterish, 
slightly acidulous, and distinctly astringent taste. 

Official Preparations. 

ConfSctio Rosae — Confectionis Rosas — Confection of Rose. — Used as an 
excipient in pill masses. 

Extr^ctum Rosae Fluidum — ExtrScti Rosae Fluidi — Fluid Extract of Rose. 

— Used chiefly as a vehicle. 

Physiological Action. — It acts like tannic acid. 

Therapeutics. — Externally and Locally. — The ointment is used 
for chapped lips and hands, and also for superficial burns and in 
erythema. 

The fluid extract is used as an application to inflamed eyes, 
buccal, aural, and anal ulcers, and in aphthous stomatitis. It has 
been employed in. conjunction with sodium salicylate to prevent 
the pitting of small-pox. Its chief use, however, is as a vehicle 
and flavoring extract. 

Administration. — The fluid extract is mainly used, an infusion 
of which is given internally. The fresh leaves, crushed, are ser- 
viceable as a poultice. 

Rubus— Rubi— Blackberry. 77. S. P. 

Origin. — The root-bark of Rubus villosus Ait., Rubus Canaden- 
sis L., and Rubus triviahs Mx., common shrubby North American 
plants. 

Description and Properties. — Thin, tough, flexible bands, outer 
surface blackish or blackish-gray, inner surface pale-brownish, some- 
times with strips of whitish, tasteless wood adhering ; inodorous ; 
taste strongly astringent, somewhat bitter. 



75° A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparation. 

Extr^ctum Rubi Fluidum — Extr^cti Rubi Fluidi — Fluid Extract of Rubus. 
— Dose, \-2 fluidrachms (2.0-8.0 Cc). 

Physiological Action. — Identical with that of tannic acid. 

Therapeutics. — Internally. — The fluid extract is used in the 
summer diarrhea of children — practically its only employment. An 
infusion of the leaves is claimed by Popoff to be an excellent 
remedy for debility of the bladder. 

Administration. — The fluid extract and the infusion are used 
as medicinal agents. The syrupus rubi idsei is used only as a 
vehicle. Blackberry cordial and blackberry brandy are favorite 
modes of administration. It is commonly believed by the laity 
that the various blackberry and raspberry preserves are eflicacious 
as remedies ; on the contrary, they are highly irritating, because of 
the seeds present in them. 



MINERAL ASTRINGENTS. 

Plumbum— Plumbi— Lead, 

The salts of lead only are used in medicine. 



Plumb! Acetas— Plumbi Acetatis— Lead Acetate. 

17. 8. P. 

(Sugar of Lead.) 

Origin. — Metallic Lead is dissolved, in the presence of air, in 
Acetic Acid, or Lead Oxide is dissolved by the aid of a gentle heat 
in Acetic Acid and Water, the solution being filtered, evaporated, 
and crystallized. 

Description and Properties. — Colorless, shining, transparent, 
monoclinic prisms or plates, or heavy, white, crystalline masses, or 
granular crystals, having a faintly acetous odor and a sweetish, 
astringent, and afterward metallic taste. On exposure to the air 
efflorescent and absorbing carbon dioxide. Soluble in 2.3 parts 
of water and in 21 parts of alcohol, in 0.5 part of boiling water, 
and in 1 part of boiling alcohol. Lead acetate should be kept in 
well-stoppered bottles. 

Dose. — J— 5 grains (0.03-0.3 Gm.). 



ASTRINGENTS. 751 

Official Preparations. 

Liquor Plumbi Subacetatis— Liquoris Plumbi Subacetatis— Solution of 
Lead Subacetate (Goulard's Extract).— Used externally and locally. (The solu- 
tion contains about 25 per cent, of Lead Subacetate.) 

Liquor Pltimbi Subacetatis Dilutus — Liquoris Pltimbi Subacetatis Diluti 
— Diluted Solution of Lead Subacetate (Lead Water).— Used externally and 
locally. (It contains 3 per cent, of Lead Subacetate.) 

Ceratum Pltimbi Subacetatis— Cerati Pltimbi Subacetatis— Cerate of Lead 
Subacetate (Goulard's Cerate).— Used externally and locally. (Goulard's Extract, 
20; Camphor Cerate, 80 parts.) 

Unofficial Preparation. 

LinimSntum Pltimbi Subacetatis — LinimSnti Pltimbi Subacetatis — LinU 
ment of Lead Subacetate. — Used externally and locally. (40 parts of Lead Sub- 
acetate to 60 parts of Cotton Seed Oil.) 

Pltimbi Carbonas— Plumbi Carbonatis— Lead Car- 
bonate. TJ.S.JP. 

(White Lead.) 

Origin. — Obtained by passing Carbon-dioxide Gas through a 
solution of Lead Acetate, or by adding an Alkali Carbonate to 
a solution of a Neutral Lead Salt. 

Description and Properties. — A heavy, white, opaque powder 
or a pulverulent mass, without odor or taste. Permanent in the 
air. Insoluble in water or alcohol, but soluble in acetic or diluted 
acetic acid, with effervescence. Lead carbonate should be kept in 
well-stoppered bottles. Used externally and locally. 

Official Preparation. 

Ungufentum Pltimbi Carbonatis — UnguSnti Pltimbi Carbonatis — Ointment 
of Lead Carbonate (10 per cent.). — Used externally and locally. 

Plumbi Iodidum— Plumbi Iddidi— Lead Iodide. 

U. S. JP. 

Origin. — Obtained by mixing a solution of Lead Nitrate and 
Potassium Iodide, and drying the precipitate. 

Description and Properties. — A heavy, bright-yellow powder 
without odor or taste. Permanent in the air. Soluble in about 
2000 parts of water and in about 200 parts of boiling water, sep- 
arating from the latter solution in brilliant golden-yellow spangles 
or crystalline laminae. Very slightly soluble in alcohol, but sol- 
uble, without color, in solutions of the fixed alkalies, in concen- 



752 A TEXT-BOOK OF MATERIA MEDICA. 

trated solutions of the acetates, of the alkalies, potassium iodide, 
and sodium hyposulphite, and in a hot solution of ammonium 
chloride. Lead iodide should be kept in well-stoppered bottles. 
Dose. — \ grain (0.13 Gm.). 

Official Preparation. 

UnguSntum Pliimbi Iodidi — UnguSnti Pliimbi Iodidi — Ointment of Lead 
Iodide (10 per cent.). — Used externally and locally. 

Plumbi NItras— Plumbi Nitratis— Lead Nitrate. 

U. S. P. 

Origin. — Prepared by dissolving Lead in Diluted Nitric Acid. 

Description and Properties. — Colorless, transparent, octahedral 
crystals, or white, nearly opaque crystals, without odor and having 
a sweetish, astringent, and afterward metallic taste. Permanent in 
the air. Soluble in 2 parts of water ; almost insoluble in alcohol. 
Used externally and locally. 

Plumbi (3xidum— Plumbi Oxidi— Lead Oxide. 

U. S. jP. 

(Litharge.) 

Origin. — Obtained by roasting Lead in air. 

Description and Properties. — A heavy, yellowish or reddish- 
yellow powder or minute scales, without odor or taste. On expo- 
sure to the air it slowly absorbs moisture and carbon dioxide. 
Almost insoluble in water and insoluble in alcohol. Soluble in 
acetic or diluted nitric acid and in warm solutions of the fixed 
alkalies. Lead oxide should be kept in well-closed vessels. Used 
externally and locally. 

Official Preparations. 

Empiastrum Pl&mbi— Emplgstra Plumbi— Lead Plaster (Diachylon Plas- 
ter). — Used externally and locally. 

(Lead Oxide or Lead Plaster is contained in Emplastrum Ammoniaci cum Hydrar- 
gyro and in Emplastra Ferri, Hydrargyri, Opii, Resinae, and Saponis.) 

UnguSntum Diachylon — UnguSnti Diachylon— Diaehylon Ointment. — 
(Lead Plaster, 500; Olwe Oil, 490; Oil of Lavender Flowers, 10.) Used externally 
and locally. 

Physiological Action. — Lead per se is practically inert ; some 
of its salts, however, particularly the acetate, possess valuable 
therapeutic properties. 



ASTRINGENTS. 753 

Externally and Locally. — Applied to the unbroken skin, lead 
salts have little if any effect, yet they act readily upon denuded 
surfaces, blanching the tissue of the parts by contraction of the 
small blood-vessels. In sores and ulcers they coagulate the 
albumin of the discharge and the protoplasm of the neighboring 
superficial cells, thus forming a protective coating for the healthier 
structure beneath. 

These salts have likewise a sedative action because of the 
decreased local circulation and the presumably depressant effect 
upon the nerve endings. Moreover, by virtue of their astringency 
they furnish valuable hemostatic and antiphlogistic remedies. In 
some cases the skin is discolored by their use. 

Internally. — Digestive System. — Lead acts immediately in the 
mouth, causing a sweet, styptic taste and coagulating the mucus. 
It contracts the cells and vessels of the entire alimentary canal, 
inducing dryness by diminished secretion. Consequent to the dis- 
turbed physiological functions of the digestive tract, the peristaltic 
movements diminish, and constipation necessarily ensues. 

Circulatory System. — The heart's action is slowed through the 
branches of the vagus by irritation of the cardiac inhibitory center. 
The pulse is lessened in volume and frequency, and lacks regularity. 

The blood takes up the lead as an albuminate, which soon 
passes into the tissues. While yet in the vascular system it inter- 
feres with the nutritive function of the corpuscles, producing by 
their destruction a watery condition of the blood. This explains 
the anemia usually present in cases of plumbism or lead-poisoning. 

Nervous System. — Both sensory and motor functions become 
deranged, especially the latter. This central irritation causes a dis- 
turbance, and finally paralysis, of various muscles. The involun- 
tary muscles appear to be most affected, and of these primarily the 
intestinal ; hence, with the assistant local effect, arise distressing 
abdominal pains and spasms. The cardiac center and vagal 
branches to the heart are influenced, as already stated. 

Respiratory System. — The irritation produced in the respiratory 
centre has an inhibitory action through the vagus upon the respira- 
tion. 

Absorption and Elimination. — The preparations of lead are con- 
verted in the stomach into an albuminate, and thence taken up by 
the blood, very little absorption taking place in the intestine, where 
the lead is converted into an insoluble sulphide. It is absorbed by 
the abraded skin, and enters directly into combination with the 

48 



754 A TEXT-BOOK OF MATERIA MEDICA. 

albumin of the tissues. A portion of the lead albuminate is elimi- 
nated by the liver with the bile into the intestine, where, being con- 
verted into a sulphide, it is excreted in that form with the feces. 
The skin, kidneys, and mammary glands assist in its elimination. 

Lead is not easily removed from the whole system, owing to its 
retention by the ubiquitous albumin ; consequently some alterative, 
such as potassium iodide, should be administered. 

Uterus. — Under the influence of lead, abortion is liable to occur 
or the child be still-born. This is probably due to a disturbance 
of the quality and quantity of the blood-supply to the affected 
parts. 

Untoward Action. — Undesirable results have followed the ad- 
ministration of medicinal doses of lead acetate, evidently arising 
from insufficient elimination. Baker observed loss of appetite, gas- 
tralgia, constipation, and paralysis of three weeks' duration. This 
last symptom occurred in the hand of a man who had taken I grain 
(.06 Gm.) of lead acetate twice daily for four days to relieve hema- 
turia. In another case attacks of colic, lasting several months, fol- 
lowed the exhibition of 4 grains (.25 Gm.) of the same salt for 
three days. Tanquere des Planches suggests caution in too free 
an administration of lead preparations, as being prone to occasion 
disagreeable symptoms. 

The external application of lead solutions and ointments some- 
times produces unpleasant effects, such as discoloration of the skin. 
In the mucous membrane lead rarely excites symptoms of poison- 
ing, a single case being reported where lead water compresses 
were applied to the eye. Gastric pains have occurred after re- 
peated applications of such compresses to a contused shoulder, the 
pains ceasing with their withdrawal and reappearing with a renewal 
of the treatment. Colic and paralysis of the member have fol- 
lowed washing of a large ulcer of the leg with lead water, these 
symptoms disappearing upon a withdrawal of the drug. In still 
another case a sweetish, styptic taste in the mouth and stiffness of 
the neck resulted from the external use of the solution. 

Poisoning. — Cases of acute poisoning are in therapeutics for- 
tunately rare, the acetate — the form generally given — producing 
emesis, thus preventing toxic effects of the drug. 

The first symptom of poisoning is a sweetish, metallic taste, 
soon followed by nausea and vomiting of a white, milky fluid con- 
taining curdy material — the result of a combination of the exces- 
sive lead with the hydrochloric acid of the gastric juice, and the 



ASTRINGENTS. 755 

formation of lead chloride. Constipation and subsequent diarrhea 
usually occur, with black passages, the discoloration being caused 
by the sulphide of lead formed in the intestinal canal. There is 
severe, persistent pain in the abdominal muscles, which are rigid 
and contracted, while a retraction of the abdominal walls is clearly 
perceptible. There are great thirst, and possibly cramps in the 
calves of the legs, neuralgic pains, muscular twitchings, vertigo, 
stupor, anesthesia, and paralysis. Tenesmus is present, and the 
face is pale and the lips livid. As a rule, the liver is retracted and 
often diminished in size. The pulse is rapid and tense at first, 
becoming weak, compressible, and slow. 

Treatment of Poisoning. — Evacuation of the stomach is impera- 
tive, the process being more or less assisted by the emetic property 
of the drug. Some sulphate should be administered in order to 
form an insoluble lead compound. Epsom and Glauber's salts are 
the best antidotes, since they are readily soluble and easily ob- 
tained; acting, moreover, as a purge, they empty the intestinal 
canal. Opium will serve to relieve pain and irritation, while to 
maintain bodily temperature hot applications can be used on the 
feet and abdomen. 

Chronic Poisoning. — The acute form of poisoning just considered 
is always produced by a soluble lead salt; chronic plumbism, on 
the contrary, is generally caused by an insoluble salt. The symp- 
toms are numerous and manifold, there being no physiological dis- 
turbance of the acute which is not present in the chronic condition. 
The train of untoward symptoms is occasioned by long-continued 
medicinal use of lead preparations. Very frequent sources of 
poisoning are : drinking water conveyed in lead pipes, and foods 
colored with chrome yellow and those contained in cans soldered 
with lead. It is especially liable to occur among painters (colica 
pictonum), manufacturers of lead salts, color-grinders, and type- 
setters and founders. 

Wrist-drop, bilateral, resulting from paralysis of the extensor 
muscles of the forearm, is one of the most prominent symptoms, 
although not a constant occurrence. The supinator longus, being 
also a flexor, usually escapes this influence. Colic, sharp abdom- 
inal pains, chiefly in the umbilical region, retraction of the abdom- 
inal muscles and cramps, and paralysis of the calves of the legs 
may be present in plumbism — or " saturnism," as it is sometimes 
termed, a word transmitted to us from medieval alchemy. Obsti- 



756 A TEXT-BOOK OF MATERIA MEDICA. 

nate constipation, with the passage of clay-colored stools, as has 
been stated, necessarily occurs ; and anorexia, gastralgia, and 
arthralgia are seldom absent. The liver, the most important me- 
dium in the elimination of the poison, in severe cases becomes 
overtaxed and reduced in size. The tongue is white and coated, 
and the skin, lips, and mucous membranes are discolored. A blue 
line on the anterior gums is pathognomonic, although it may be 
absent in those who take special care of the teeth. 

Headache, delirium, and epileptiform convulsions, constituting 
encephalopathia saturnina, may occur, being usually due to uremia 
induced by insufficient elimination of the poison. Albuminuria, 
anemia, cirrhosis, and contraction of the kidneys, with diminished 
excretion of uric acid, are present, and amblyopia and amaurosis 
may be included among the symptoms. The heart and the entire 
vascular system are, as has been said, considerably deranged. 
Multiple neuritis, anterior poliomyelitis, and atrophy of the nerve- 
trunks, with resultant muscular wasting and loss of power, grad- 
ually manifest themselves. Gout sometimes occurs, and, as noted 
in acute poisoning, miscarriage is liable to take place. 

Treatment of Poisoni?ig. — The sulphates are given for their 
chemical and purgative effects, yet in chronic plumbism the hepatic 
purgatives — calomel, gamboge, jalap, etc. — are preferable. Opium 
and morphine relieve pain and spasms, being claimed by some 
authorities as specifics in lead-poisoning. Sulphuric-acid lemonade 
and plenty of milk have been found beneficial. Potassium iodide 
in ten-grain doses, three times daily, has an eliminative effect. The 
cerebral symptoms may be alleviated by a diaphoretic, such as 
pilocarpin or an alcohol sweat. 

In progressive paralysis strychnine is widely employed. Fara- 
dization of the muscles, if they respond, or otherwise galvanization, 
should be used to increase muscular force and prevent atrophy. 

Plumbi Acetatis. — This being the typical lead salt, its action 
will be first considered. 

Therapeutics. — Externally and Locally. — It acts as a sedative 
as well as an astringent in acute inflammations, such as eczema (not 
chronic), impetigo, lichen, and erythema ; but it must not be used 
stronger than 10 grains (0.64 Gm.) to I ounce (30.0 Cc.) of water. 

It is of service as an injection in gonorrhea, leucorrhea, gleet, 
and otorrhea. In combination with opium it makes a good topical 
application for hemorrhoids. As a gargle it is of some value, and 
is also serviceable in orchitis, synovitis, and paronychia. 



ASTRINGENTS. 



/O/ 



Internally. — Its most important use is in checking hemorrhages, 
in which it is associated with opium, although it is chemically in- 
compatible with that drug. It is of service in hemorrhage in typhoid 
fever, yellow fever, hemoptysis, and gastric nicer. It lowers the 
heart's action, constringing the arterioles, in this respect resembling 
digitalis, combined with which drug it is beneficial in hypertrophy 
of the heart. 

Morbid discharges, such as the night-sweats and diarrhea of phthi- 
sis and the diarrhea of typhoid, dysentery, cholera infantum, secretions 
in bronchorrhea, and serous diarrhea, are effectually checked by the 
acetate of lead and opium, which diminishes the pain, griping, and 
tenesmus attending the respective affections. By far its most fre- 
quent use, however, is in serous diarrheas, the drug acting very 
quickly and efficiently, and being both sedative and astringent. 

Given in chronic gastritis with pain, lead acetate affords marked 
relief. It was at one time advocated in internal aneurysm, but is 
of little if any value in this respect. 

Liquor Plumbi Subacetatis. — This preparation is used exten- 
sively for bruises, sprains, acute eczema, and as a cooling application 
in ecthyma, erysipelas, and all kinds of inflammations ; it should 
be well diluted. It also relieves the itching of urticaria, pruritus 
pudendi, and eczema. 

A felon may be aborted by saturating bread-crumbs with 
Goulard's solution, making a poultice, and placing it over the finger. 

Plumbi Iodidi. — Used very little. It acts beneficially when 
employed as an ointment applied to enlarged lymphatic glands and 
spleen ; also for psoriasis and chronic eczema. 

It is given in 1-2 grain- (0.06-0.12 Gm.) doses to reduce malarial 
spleen. 

Carbonate of lead is used only externally, in the form of an 
ointment, for burns, scalds, erysipelas, and intertrigo. It should 
never be applied to abraded surfaces, as it is rapidly absorbed. It 
should be mixed with linseed oil. 

Plumbi Oxidum. — Hebryre commends an application of equal 
parts of lead plaster and linseed oil for sweating of the feet. It is 
chiefly used in the preparation of diachylon or lead-plaster, emplas- 
trum saponis and emplastrum resinae being also prepared with the 
oxide. 

Plumbi Nitras. — Used with good results in onychia and also 
in the manufacture of Ledoyne's disinfectant. It is an excellent 
remedy for fissured nipples, care being taken to wash the nipple 



758 A TEXT-BOOK OF MATERIA MEDICA. 

before suckling. Should the fissures be deep, it is well to wash 
the nipple with morphine sulphate or a little cocaine, as the lead 
application is exceedingly painful. 

It destroys the fetid odor arising from gangrenous sores and 
offensive discharges from the ears, nostrils, rectum, and vagina. 
It has also proved serviceable in epithelioma. 

Chloride of lead and tannate of lead have been used ex- 
ternally as ointments — the chloride to allay pain and arrest morbid 
growths, and the tannate in threatening bed-sores. 

Administration. — Locally a watery solution of lead acetate, 10 
grains (0.64 Gm.) to 1 ounce (30.0 Cc), is used. Powdered opium 
can be added, 1 drachm to the pint of water. Applied to mucous 
membranes or used as an injection, 2 grains (0.12 Gm.) to 1 ounce 
(30.0 Cc.) of water, or 5 grains (0.32 Gm.) of the acetate and 5 (0.32 
Gm.) of zinc sulphate in 1 ounce (30.0 Cc.) of water — rose-water, 
for instance — proves a most efficient application. Suppositories for 
hemorrhoids may contain 1 grain (0.06 Gm.) of opium to 3-5 grains 
(0.19-0.32 Gm.) of the acetate. The pilulae plumbi cum opio — lead 
acetate 3 grains (0.19 Gm.), opium 1 grain (0.06 Gm.) — is mostly used 
internally, one pill being taken every three hours. In dysentery and 
cholera infantum an enema containing 5 grains (0.32 Gm.) of lead 
acetate to 1 grain (0.06 Gm.) of opium, or \ grain (0.03 Gm.) of 
morphine to 1 ounce (30.0 Cc.) of water, gives excellent results. 

Should there be any abrasion of the skin, lead subacetate must 
not be used, as it prevents healing by constringing the edges of 
the wound. 

It is not used internally. 

Solution of subacetate of lead is most frequently used in union 
with opium, forming the well-known L. and L., or lead-water-and- 
laudanum, solution. It is also used in conjunction with glycerin, 
1 ounce of each, or as Goulard's cerate, consisting of 20 parts 
Goulard's extract to 80 parts camphor cerate. 

For ulcers, fissured nipples, and epithelioma lead nitrate is used, 
chiefly in the powdered form. In the nose, ears, vagina, and rectum 
a douche (2-5 grains (0.13-0.32 Gm.) to 1 ounce (30.0 Cc.) of water) 
is used. A solution of 10 grains (0.64 Gm.) to 1 ounce (30.0 Cc.) 
of glycerin or brandy is a very good application for sore nipples. 

ZTncum— Zinci— Zinc. U. S. I>. 

Origin. — Obtained by roasting the native Zinc Sulphide or Car- 
bonate, and reducing the resulting oxide with charcoal. 



ASTRINGENTS. 759 

Description and Properties. — A bluish-white metal, showing 
a crystalline fracture and having a specific gravity ranging from 6.9 
when it is cast to 7.2 after it is rolled. Soluble in diluted sulphuric 
or hydrochloric acid, with evolution of hydrogen gas. 

Metallic zinc occurs in the form of thin sheets or in irregular, 
granulated pieces, or moulded into thin pencils, or in a state of 
fine powder. 

The following salts of zinc are official : 

Zinci Acetas — Zinci Acetatis — Zinc Acetate. — Origin. — Obtained by dissolv- 
ing Zinc Acetate in Acetic Acid and Water and boiling : zinc acetate crystallizes out. 

Description and Properties. — Soft, white, six-sided, monoclinic plates, of a pearly 
luster, having a faintly acetous odor and an astringent metallic taste. Exposed to the 
air, the salt gradually effloresces and loses some of its acid. Soluble in 2.7 parts of 
water and 36 parts of alcohol. Zinc acetate should be kept in well-stoppered bottles. 

Dose. — As a tonic, %-2 grains (0.03-0.12 Gm.) ; as an emetic, 10-30 grains 
(0.6-2.0 Gm.) ; but principally used externally and locally. 

Zinci Carbonas Praecipitatus — Zinci Carbonatis Praecipitati — Precipitated 
Zinc Carbonate. — Origin. — Prepared by pouring together solutions of Zinc Sulphate 
and Sodium Carbonate, and drying the precipitated zinc salt. 

Description and Properties. — An impalpable white powder, of somewhat variable 
chemical composition, without odor or taste ; permanent in the air. Insoluble in water 
or alcohol. 

Dose. — 2-3 grains (0.12-0. 18 Gm.). Chiefly used externally. 

Zinci Iodidum — Zinci Iodidi — Zinc Iodide. — Origin. — Prepared by dissolving 
Zinc Oxide or Carbonate in Hydriodic Acid. 

Description and Properties. — A white, granular powder, odorless, having a sharp, 
saline, and metallic taste. Very deliquescent, and liable to absorb oxygen from the air, 
becoming brown from liberated iodine. Readily soluble in water, alcohol, or ether. 
Zinc iodide should be kept in small glass-stoppered bottles. 

Dose. — yi-2 grains. (0.03-0.12 Gm.). Also used externally. 

Zinci SOlphas — Zinci Sulphatis — Zinc Sulphate. — Origin. — Prepared by dis- 
solving Granulated Zinc in Sulphuric Acid, certain precautions being taken to remove 
impurities. 

Description and Properties. — Colorless, transparent, rhombic crystals, without odor, 
and having an astringent, metallic taste. Efflorescent in dry air. Soluble in 0.6 part 
of water and in 3 parts of glycerin ; insoluble in alcohol. Zinc sulphate should be kept 
in well-stoppered bottles. 

Dose. — 1-3 grains (0.06-0.18 Gm.) ; as an emetic, 10-60 grains (0.6-4.0 Gm.1. 

Zinci Oxidum — Zinci Oxidi — Zinc Oxide. — Origin. — Prepared by heating Zinc 
Carbonate to redness in a crucible. 

Description and Properties. — An amorphous white powder without odor or taste. 
Insoluble in water or alcohol. It should be kept in well-stoppered bottles. 

Dose. — 1^-5 grains (0.015-0.3 Gm.). 

Official Preparations of Zinc Oxide. 
UnguSntum Zinci Oxidi — UnguSnti Zinci Oxidi — Ointment of Zinc Oxide 

(20 per cent.). — Used externally and locally. 

Antagonists and Incompatibles. — The salts of zinc are incom- 



760 A TEXT-BOOK OF MATERIA MEDIC A. 

patible with the vegetable astringents, alkalies and their carbonates, 
lime water, the sulphides, silver nitrate, lead acetate, and milk. 

Synergists. — The same as for lead. 

The metallic form is not used in medicine. 

Physiological Action. — Externally and Locally. — The zinc salts 
resemble the lead salts in their action, but they are less powerful 
astringents. They are also to a slight extent hemostatic. The 
chloride is exceedingly caustic. 

Internally. — Digestive System. — The sulphate of zinc and, in a 
slight degree, the carbonate are specific emetics, causing rapid 
emesis, with but little nausea or depression. Their modus operandi 
is not definitely known, but it is believed that their effects are 
partly due to local action on the stomach, and partly to stimulation 
of the vomiting center in the medulla. 

Vomiting is also produced by injecting a solution of the salt 
into the circulation ; but this is doubtless owing to the fact that 
the salt is excreted by the stomach, and that it also exerts an 
influence on the medullary center. 

The salts of zinc also act as astringents upon the gastrointes- 
tinal mucous membrane. 

Circulation, — Zinc salts, when introduced into the circulation 
directly, caused a depression of the heart's action, resembling in 
that, as in other regards, the action of copper, with which metal its 
general effects are most closely allied. The blood pressure is 
affected but slightly. The pulse is somewhat slowed, especially 
just before death. With the blood, zinc forms new hemoglobin 
compounds (zinc-hemol). 

Nervous System. — Zinc produces a depression of the central 
nervous system. When introduced intravenously, it may cause 
paralysis of the extremities. 

Absorption and Elimination. — Zinc is taken up from the stomach 
and intestine and is found in largest quantities in the liver and bile. 
It is also found in the kidneys, pancreas, spleen, and thyroid. It 
is not held in the body in as stable a condition as the lead salts, 
and is less liable to bring about chronic poisoning. It is largely 
eliminated by the kidneys and bile. The salivary, milk, and intes- 
tinal secretions also eliminate some. In its passage through the 
kidneys zinc is an irritant, causing, in poisoning, a parenchymatous 
nephritis. 

Untoward Action. — 3-5 grains (0.19-0.32 Gm.) have produced 
nausea and gastric oppression, while if the zinc salt reaches the intes- 






ASTRINGENTS. 761 

tines diarrhea results. When taken on a full stomach the salts form an 
insoluble albuminate which undergoes the regular digestive process. 

Repeated small doses, 3 grains (0.19 Gm.), have produced gastric 
oppression, eructations, slight confusion of thought, dizziness, bodily 
exhaustion, thirst, gastralgia, vomiting, and diarrhea. Zinc dyscra- 
sia may follow, characterized by obstinate constipation, emaciation, 
and anemia. 

Poisoning. — Continued use or excessive doses of zinc will pro- 
duce poisoning, with symptoms resembling those of lead-poisoning. 

Chronic Zinc Poisoning. — Among zinc workers there is a type 
of poisoning known as " zinc-founders' fever," or ague. The 
attacks are frequently acute. After pouring a mould, the worker 
may have a sense of general distress, with backache and irregular 
muscular pains and lassitude. There is no disturbance of the 
pulse or of temperature. Shortly following this chills may develop, 
the pulse is increased to 100 or 120, and there are cough, pain in 
the chest, and headache. Profuse perspiration marks the climax 
of the attack, and the patient has labored sleep and recovers. 

It is not improbable that the accompanying salts of arsenic and 
lead, always found in commercial zinc, are responsible, in part at 
least, for some of these symptoms. 

Treatment of Poisoning. — Chemical antidotes are the bicarbon- 
ates of soda and potassium. Flour and water, soapsuds, and milk 
are also beneficial. Morphine given hypodermically relieves the 
vomiting. Laxatives and potassium iodide may serve later to 
assist in eliminating the zinc. 

Therapeutics. — Zinc Oxide. — Externally and Locally. — The 
ointment or powder is used in chronic eczema, intertrigo, burns, fis- 
sured nipples, anal fissure, idcers, and skin diseases. In combination 
with linseed oil the oxide has also been used in erysipelas. The 
drug has proved useful as an injection in leucorrhea. 

Internally. — Associated with bismuth, sodium bicarbonate, or 
belladonna, it is very effective in diarrhea — particularly the summer 
diarrhea of children — and dysentery. 

It is a most excellent remedy for colliquative sweating and the 
sweating of phthisis, and also serves to check the profuse secretion 
of bronchorrhea, although its use may occasion disordered diges- 
tion, since zinc is but sparingly soluble. 

It has been used extensively in the treatment of hysteria, spas- 
modic asthma, chorea, and epilepsy ; yet, even though it is claimed 
to be a specific, its action as such is exceedingly doubtful. 



762 A TEXT-BOOK OF MA TERIA MEDICA. 

Zinc oxide has proved highly beneficial in whooping cough, de- 
lirium tremens, and chronic alcoholism — especially the two latter, 
which are attended with considerable nervousness. 

The oxide is also valuable in gastralgia. 

Zinc Acetate. — It is used only externally and as an injection in 
gonorrhea and leucorrhea. In conjunctivitis it is useful as a collyrium. 

Zinc Sulphate. — Externally and Locally. — The external use is 
chiefly in weeping eczema, pruritus, and ulcers. Locally it is of ser- 
vice as a wash in ophthalmia and conjunctivitis, and as an injection 
in goiiorrhea, leucorrhea, vulvitis, and otitis. It is also used in gan- 
grenous stomatitis, cancrum oris, and as a gargle in enlarged tonsils 
and relaxed sore throat. In nasal polypi the powder is insufflated, 
the solution being applied to the stump after removal of the poly- 
pus. It dries up soft tumors near the vagina, anus, and female 
urethra. It is also used in lupus exedens and cancer of the breast, 
but does not act upon parts covered by epithelium. Its application 
is very painful, but the eschar does not tend to spread, and sepa- 
rates much more readily than those of many other caustics. 

Internally. — Its chief use is that of an emetic after ingestion of 
poison, irritating foods, and especially narcotics, as well as where 
the air-passages are obstructed, as in croup and diphtheria. 

It acts as an astringent in chronic diarrhea and dysentery when 
associated with opium and ipecac. It is serviceable in typhoid fever \ 
flatident dyspepsia, coursing oxaluria, spasmodic asthma, and whoop- 
ing cough. Like the other zinc salts, it has also been used in 
hysteria, chorea, epilepsy, and angina pectoris. 

Zinc Carbonate. — This preparation is used only externally, for 
blisters, weeping eczema, and intertrigo. It is employed in the form 
of a powder, but generally as an ointment — cardamine ointment. 

Zinc Iodide. — This salt is but little used, but is of some value 
as a gonorrheal injection, as an application to enlarged and indu- 
rated tonsils, and in scrofulous glands. 

Zinc phosphide and zinc valerianate are used only for the 
bertefit derived from the phosphorus and valerianic acid, and may 
properly be omitted here. 

A long list of newer compounds of zinc have been given by the 
synthetic chemists. Some are of service, but they should be 
employed with understanding. The most important are the borate, 
chrysophanate, cyanid, gynocardate, hemol, zinc, ichthyol sulfonate, 
permanganate, salicylate, sozoiodolate, stearate, subgallate, and 
sulphocarbolate. 



ASTRINGENTS. 763 

Administration. — Externally the powder or ointment of zinc 
oxide is used, or the drug may be mixed with powdered starch, 
lycopodium, or acacia. Before applying these preparations it is 
well to wash the parts with a weak solution of carbolic acid. 

Internally, \ grain (0.0 1 Gm.) zinc oxide and 3 grains (0.19 Gm.) 
sodium bicarbonate are given in diarrhea, or, if preferable, bismuth 
subnitrate 10 grains (0.64 Gm.), pepsin (Sheffer's) 3 grains (0.19 Gm.), 
and zinc oxide \- 1 grain (0.03-0.06 Gm.), with a little opium added. 

As an injection a combination of 10 grains (0.64 Gm.) each of zinc 
sulphate and lead acetate is used, the two salts interacting and pro- 
ducing lead sulphate — which is precipitated and insoluble — and zinc 
acetate. 

Locally and externally the dry powder of zinc sulphate is 
used, or a mixture of zinc sulphate 10 grains (0.64 Gm.), aqua rosae 

4 ounces (118.29 Cc), and glycerin 1 drachm (4.0 Cc), as a lotion. 
As an injection it is associated with lead acetate, forming the zinc 
acetate and lead sulphate. In ophthalmia neonatorum zinc sulphate 

5 grains (0.32 Gm.), morphine sulphate 3 grains (0.19 Gm.), and 
aqua rosae 1 ounce (30 Cc), perhaps with atropine added, form 
an excellent mixture. 

Internally, in dyspepsia 1-2 grains (0.06-0.12 Gm.) maybe given, 
and for intestinal affections 1 grain (0.06 Gm.) each of the sulphate, 
powdered opium, and ipecac three times daily. To produce emesis 
5 grains (0.32 Gm.) are sufficient 

The collyrium consists of J grain (0.03 Gm.) of the salt in I 
ounce (30 Cc.) of rose water. 

Cupri Sulphas— Cupri Sulphatis— Copper Sulphate. 

U. S. P. 

Origin. — Prepared by heating Copper and Sulphuric Acid to- 
gether, dissolving the soluble product in hot Water, and evaporating. 

Description and Properties. — Large, transparent, deep blue 
triclinic crystals, odorless, of a nauseous, metallic taste ; slowly 
efflorescent in dry air. Soluble in about 2.6 parts of water and in 
0.5 part of boiling water ; almost insoluble in alcohol. 

Dose. — |— i- grain (0.008-0.03 Gm.), as an astringent; as an 
emetic, 2-20 grains (0.12-1.2 Gm.). 

Antagonists and Incompatibles. — Alkalies and their carbon- 
ates, the sulphides, mineral salts (except the sulphates), lime water, 
the iodides, and vegetable astringents. 

Synergists. — The same as for lead. 



764 A TEXT-BOOK OF MATERIA MEDICA. 

Physiological Action. — Copper sulphate is the salt mostly 
used, and the only official preparation. Its action is therefore given 
as characteristic of that of cuprum. 

Externally. — Applied to the unbroken skin, it produces little 
effect, but on raw surfaces or mucous membranes it acts as a pain- 
ful caustic and astringent. It also possesses antiseptic properties. 

Internally. — Digestive System. — It acts as an irritant, causing 
vomiting of greenish matter, though nausea does not follow the 
emesis. The secretions are augmented, and salivation and purging 
of blood and mucus are attendant consequences of its ingestion. 
Should emesis be delayed, the stomach should immediately be 
emptied, otherwise the copper is liable to produce inflammation. 

Circulatory System. — Copper exists normally in the blood, and 
acts as a tonic, being present in the circulation as an albuminate. 
It depresses the heart's action, causing a small, weak, rapid pulse. 

Nervous System. — It acts as a depressant. 

Respiratory System. — Its influence is to hasten and depress the 
respiratory movements. 

Absorption and Elimination. — Copper salts are slowly absorbed, 
tending to accumulate in the liver. The drug is eliminated by the 
liver, kidneys, salivary glands, and intestinal canal. 

Poisoning. — Acute poisoning results from the inhalation of 
cupreous fumes, eating fruits cooked in copper vessels, or from 
an overdose of a copper salt. 

When inhaled the first symptoms are those of bronchial catarrh 
and irritation. Internally administered, the symptoms do not usually 
appear at once, but after an hour's interval there are manifest a 
strong metallic taste in the mouth, burning and constriction of the 
pharynx and fauces, salivation and vomiting of greenish matter, and 
purging, the passages after a while containing mucus streaked with 
blood. There are present also burning in the epigastrium and 
griping, colicky pains. 

Copper enters the circulation quickly, it being highly diffusible. 
A characteristic symptom of poisoning is a green line on the gums. 
Sometimes jaundice may be present, and headache, convulsions, 
suppression of urine, cardiac depression, and hurried respiration are 
among the graver symptoms. 

Treatment of Poisoning. — A chemical antidote should be given 
at once, potassium ferrocyanide being the best, as it forms an in- 
soluble copper cyanide. Other recourses are white of egg, milk, 
sweet oil, emetics, and the use of the stomach-pump. A mustard 



ASTRINGENTS. 765 

plaster, with a little opium added to allay the pain and irritation, 
may be applied over the pit of the stomach as a counter-irritant. 
Should vomiting have already occurred, emetics should be with- 
held. 

Chronic poisoning usually results from long-continued use of 
the medicine. The symptoms are the same as those of acute poi- 
soning, with the following superadded : paresis of the limbs, paral- 
ysis, incoordination of muscles, atrophy of the liver, with fatty 
degeneration of the liver-cells, and proliferous growth of the con- 
nective tissue. There may also be present congestion of the lungs 
and fatty degeneration of the kidney, together with bronchial 
catarrh. The treatment is the same as for acute poisoning. 

Therapeutics. — Externally and Locally. — Copper sulphate 
stimulates old, flabby, granulating ulcers. Ring-worm, scabies, and 
tinea sycosis derive great benefit from its use. 

The crystal or solution, 2 grains to 1 ounce (0.12-32.0 Gm.) of 
water, is used extensively in conjunctivitis, tinea tarsi, and trachoma 
condylomata, and as a gargle in relaxed sore throat. The aphthae 
in aphthous stomatitis are benefited by touching with the copper- 
sulphate solution. It is also used as an injection in gonorrhea and 
gleet, 2 grains to 1 ounce (0.12-32.0 Gm.). It is also valuable in 
mercurial sore mouth and gangrene of the pharynx. 

Internally. — Copper sulphate is the chemical antidote for 
phosphorus-poisoning, yet it should be given with great caution, 
lest of itself it produce acute poisoning. It is a speedy emetic, 
since it acts directly upon the stomach. If emesis is not produced 
by the first dose, sulphate of zinc or mustard may be employed. 
It is used as an emetic in croup. 

In chorea, hysteria, and epilepsy copper is beneficial. In chronic 
dysentery and diarrhea an enema of a pint of water (512.0 Gm.) 
and 10 grains (0.6 Gm.) of sulphate of copper is an efficient 
remedy, being by some authors considered the best metallic 
astringent in chronic dysentery. 

Copper associated with arsenic is highly beneficial in anemia, 
building up the blood and adding firmness to the flesh. 

Oleate of copper is used in the skin affections mentioned. 

Nitrate and acetate of copper act like the sulphate. 

Arsenite of copper has been suggested as a remedy in anemia, 
and has been used in doses of jfa grain (0.0006 Gm.) in diarrhea 
and cholera infantum. 

Administration. — For an enema in diarrhea and dysentery it 



766 A TEXT-BOOK OF MATERIA MEDIC A. 

maybe combined with opium — 2 grains to 1 ounce (0.12-32.0 Gm.) 
of water being used. For eye affections the crystal or solution 
is employed. In addition to the enema copper sulphate, 1 grain 
(0.06 Gm.) may be united with magnesium sulphate 1 ounce 
(32.0 Gm.) and I drachm (4.0 Gm.) diluted sulphuric acid in 4 
ounces (128.0 Gm.) of water, a tablespoonful of the mixture being 
given every three or four hours. To produce emesis 10-15 grains 
(0.6-1 Gm.) are dissolved in about 5 ounces (160.0 Gm.) of water, 
a tablespoonful being given every ten minutes until vomiting is 
produced. 

Argenti Cyanidum— Argenti Cyanidi— Silver Cya- 
nide. U. S. JP. 

Origin. — Obtained by distilling a solution of Potassium Ferro- 
cyanide acidulated with Sulphuric Acid, the distillate passing into 
a receiver containing a solution of Silver Nitrate. The process 
should be continued until the distillate no longer produces a 
precipitate in the receiver. The precipitate is finally washed with 
distilled water and dried. 

Description and Properties. — A white powder, without odor 
or taste ; permanent in dry air, but gradually turning brown on 
exposure to light. Insoluble in water, alcohol, or cold nitric acid ; 
soluble in boiling nitric acid, ammonia water, and solution of 
sodium hyposulphite or potassium cyanide. It should be kept in 
dark, amber-colored vials, protected from light. Not used internally. 

Official Preparation. 

Acidum Hydrocy^nicum Dilutum — Acidi Hydrocy&nici Diluti — Diluted 
Hydrocyanic Acid (Prussic Acid). — Dose, 2-5 minims (0.12-0.3 Gm.). (Described 
under Hydrocyanic Acid, page 545.) 

Argenti Iodidum— Argenti lodidi— Silver Iodide. 

IT. S. P. 

Origin. — Prepared from Silver Nitrate and Potassium Iodide, 
washing and drying the precipitate. 

Description and Properties. — A heavy, amorphous, light-yel- 
lowish powder, unaltered by light if pure, but generally becoming 
somewhat greenish-yellow ; without odor or taste. Insoluble in 
water and alcohol. Silver iodide should be kept in dark, amber- 
colored vials, protected from light. 

Dose. — J-i grain (0.015-0.06 Gm.). 



ASTRINGENTS. 767 

Argenti NItras— Argenti Nitratis- Silver Nitrate. 

U. S. JP. 

Origin. — Obtained by dissolving Silver in Nitric Acid with the 
aid of heat, evaporating, and crystallizing. 

Description and Properties. — Colorless, transparent, tabular, 
rhombic crystals, becoming gray or grayish-black on exposure to 
light in presence of organic matter. Without odor, but having a 
bitter, caustic, and strongly metallic taste. Soluble in 0.6 part of 
water and in 26 parts of alcohol. It should be kept in dark, 
amber-colored vials, protected from light. 

Dose. — J-i grain (0.015-0.06 Gm.). 

Official Preparations. 

Argfenti NItras Dilutus — ArgSnti Nitratis Diluti — Diluted Silver Nitrate 

(Mitigated Caustic). — Origin. — Prepared by fusing together Silver Nitrate 30, and 
Potassium Nitrate 60, and casting in suitable moulds. 

Description and Properties. — A white, hard solid, generally in the form of pencils 
or cones of a finely granular fracture, becoming gray or grayish-black on exposure to 
light in the presence of organic matter ; odorless, having a caustic, metallic taste, neutral 
to litmus-paper. It should be kept in dark, amber-colored vials. Used externally. 

ArgSnti NItras Fusus — ArgSnti Nitratis Fiisi — Moulded Silver Nitrate 
(Lunar Caustic). — Origin. — Obtained by melting Silver Nitrate 100, Hydrochloric 
Acid 4, and pouring the melted mass into suitable moulds. 

Description and Properties. — A white, hard solid, usually cone- or pencil-shaped, of 
a fibrous fracture, becoming gray or grayish-black on exposure to light in presence of 
organic matter ; odorless, having a bitter, caustic, and strongly metallic taste. Soluble 
in 0.6 part of water and in 26 parts of alcohol. The product should be kept in dark, 
amber-colored vials, protected from light. Used externally and locally. 

Argenti Oxidum— Argenti Oxidi— Silver Oxide. 

TJ. S. P. 

Origin. — Prepared by shaking a solution of Silver Nitrate with 
solution of Potassa and washing the precipitate. 

Description and Properties. — A heavy, dark, brownish-black 
powder, liable to reduction by exposure to light ; odorless, with a 
metallic taste; very slightly soluble in water and insoluble in 
alcohol. 

Dose. — J-2 grains (0.03-0.12 Gm.). 



Antagonists and Incompatibles. — The silver nitrate is incom- 
patible with the alkalies and their carbonates, chlorides, hydro- 
chloric and tannic acids, potassium iodide, solutions of arsenic, and 
many of the organic acids. 



768 A TEXT-BOOK OF MA TERIA MEDICA. 

Silver oxide is rapidly oxidized, forming explosive compounds 
with chlorides and organic substances. 

Synergists. — Preparations of copper, lead, and zinc aid the 
action of silver salts. 

The silver nitrate and its preparations and the silver oxide are 
the only salts which possess any value as astringents or caustics. 
The silver nitrate is the typical astringent salt, and its physiological 
action will be hereafter considered. 

Physiological Action. — Metallic silver is practically of no use 
in medicine, though of great value in surgery, because of its inert- 
ness. Silver nitrate is the salt of silver chiefly employed. 

Externally and Locally, — It is a powerful caustic, but does not 
wound very deeply, as it forms an eschar by coagulating the albu- 
min of the tissue, thus protecting the underlying structures. The 
eschar is white, but on exposure to light very soon becomes black, 
owing to the fact that the silver is reduced to its metallic state. 

Like lead salts, silver salts are hemostatic. They are severely 
irritant to mucous membranes when used in solution. 

Internally. — Digestive System. — The drug causes increased secre- 
tion of intestinal glands and larger flow of bile. Silver salts are 
changed in the stomach into peptonates and albuminates. Under 
ordinary doses nutrition is promoted ; by large doses it is impaired, 
with resulting loss of flesh and weight. 

Circulatory System. — The heart is stimulated by small doses, 
and the blood becomes darker and contains less fibrin. The 
red corpuscles lose shape and color and the hemoglobin is con- 
verted into hematin. Large doses depress cardiac action, while 
thrombosis and embolism may ensue. 

Nervous System. — In small doses silver salts are tonic ; in large 
doses they produce epileptiform convulsions and paralysis of centric 
origin. 

Respiratory System. — The primary effect of the drug is to stim- 
ulate respiration. Large doses, however, cause death by paralysis 
of the respiratory center. 

Absorption and Elimination. — It is absorbed from the stomach 
and eliminated very slowly, chiefly by the feces, a small portion 
being excreted by the kidneys. 

Temperature. — At first increased ; afterward, through the blood- 
changes, lowered. 

Untoward Action. — Long-continued use of silver nitrate pro- 
duces discoloration of the skin (argyria) either general or more 



ASTRINGENTS. 769 

pronounced in particular spots, such as the face. Even when the 
skin is perfectly intact the application of nitrate of silver will dis- 
color it, \ grain (.016 Gm.) having caused palpitation of the heart 
and irregular pulse. Silver accumulates in the tissues. 

Poisoning. — A poisonous dose of silver nitrate produces a violent 
gastro-enteritis. The earliest symptom is an intense pain in the 
abdomen, followed by vomiting and purging. The abdominal 
muscles are hard and retracted, the face livid and covered with 
perspiration and wearing an anxious expression. The lips are 
blanched, gradually becoming black ; the vomited matter is black- 
ish and sometimes resembles milk-curds. 

Epileptiform convulsions, delirium, and paralysis ensue, the 
latter symptom being of centric origin. 

Death results from cessation of respiration, due to the centric 
paralysis. A large amount of mucus is thrown into the bronchial 
tubes by the lining mucosa. 

Treatment of Poisoning. — The chemical antidote is common salt. 
It is essential to protect the mucous membrane of the esophagus 
and stomach, and at the same time dilute the poison as much as 
possible, for which purposes large quantities of salt water and soap 
water or milk are valuable. Opium allays the pain and irritation. 

Chronic poisoning, or argyria, results from prolonged medicinal 
use of silver nitrate or its employment as a hair-dye for any length 
of time. The drug is deposited in all parts of the body, being 
especially manifest in a slaty, permanent discoloration of the skin. 
The first symptoms are discoloration of the sclerotic conjunctivae 
and a dark line on the inner side of the lips. Ulcerative stomatitis 
may occur, or even gastric ulcer. 

Treatment of Chronic Poisoning. — There is no known method 
of curing argyrosis when once developed. One hundred and fifty 
grains seems the limit beyond which argyria will appear. Argy- 
rosis has been known to occur after continued local applications of 
nitrate of silver to the larynx and pharynx. 

Therapeutics. — Externally and Locally. — A very important use 
of silver nitrate is that of preventing ophthalmia neonatorum, 
a 2 per cent, solution being dropped into the eyes. For adults a 2 
to 4 per cent, solution is used in various forms of conjunctivitis, the 
eyelids being painted with a camel's-hair brush, and the solution 
being washed off immediately to prevent discoloration. The nitrate- 

of-silver stick may also be used. 
49 



770 A TEXT-BOOK OF MATERIA MEDICA. 

Felons, boils, and bed-sores may be aborted by the use of a strong 
solution — 20 grains to I ounce — of silver nitrate. 

An injection of 2-3 grains (.12-20 Gm.) is beneficial in subacute 
gonorrhea and leucorrhea. This may also be used as a wash in 
pruritus ani and vulvce, to relieve the itching. The stick may be 
applied to uterine ulcers. 

As a caustic it is used in indolent idcers and chancroids, stimu- 
lating them and producing a healthy granulating surface. 

A solution painted over the eruption of variola is supposed to 
prevent pitting. The vesicles may also be punctured with a needle 
and the silver nitrate then introduced. 

The pain and swelling of orchitis and epididymitis are consid- 
erably relieved by painting the scrotum with a solution of this 
salt. 

After a cold, when the throat feels raw and sore, an application 
of 60 grains (4.0 Gm.) to the ounce (30.0 Cc.) is very beneficial, and 
the same may be used in inflammations of the pharynx, fauces, and 
month. A spray of 40 grains (2.59 Gm.) to the ounce (30.0 Cc.) 
is very effective in laryngeal croup, trachitis, chronic ulceration of the 
larynx, and whooping-cough. The caustic pencil is used in tonsil- 
litis, sore nipples, mercurial sore mouth, and poisoned, lacerated, and 
punctured wounds. A solution of 1-2 grains (.06-. 12 Cc.) to the 
ounce (30.0 Cc.) is valuable in otorrhea, vesical catarrh, and 
balanitis. 

Internally. — Dr. Pepper recommends this salt in intestinal ulcer- 
ations, given in keratin-coated pills. It is a cure for gastric ulcer, 
in which it may be combined with opium. Gastralgia and chronic 
gastritis, ulceration of the rectum, dysentery, and diarrhea of typhoid 
have been remarkably benefited by its use. For stomach affections 
•J— \ grain (.01-016 Gm.) is given, and for intestinal an enema of 
3-10 grains (.20-.64 Gm.) to the ounce (30.0 Cc). 

It has been used in congested conditions of the cord, locomotor 
ataxia, epilepsy, and chorea. It is the only remedy of any value in 
locomotor ataxia ; but, owing to the discoloration it produces, it 
cannot be used continuously, and in many cases it fails entirely. 

Argentic iodide was once used extensively in the treatment 
of syphilis, but is now obsolete. 

Argentic oxide is not so active as the nitrate. It has been 
employed for checking sweats, and, owing to its less caustic action, 
it may be preferable to the nitrate in gastric ulcer and gastralgia. 

Administration. — The dose of silver nitrate is \~ \ grain (.01- 



ASTRINGENTS. 771 

.016 Gm.), and for a constitutional effect should always be given in 
pill form during the process of digestion. 

The keratin-coated pill is to be administered for intestinal dis- 
orders, and when a local action on the alimentary canal is desired 
an ordinary pill should be given one to two hours before meals. 

It is well to discontinue the drug for a short time after three or 
four weeks' treatment, the salt being so slowly eliminated that its 
prolonged use is very apt to result in argyria. 

Newer Preparations of Silver. 
Within recent years a number of new compounds of silver have 
been placed on the market. These have been devised to obviate, 
in part, the irritating effects of silver nitrate, as well as to avoid the 
limited action of this drug because of its property of coagulating 
proteids. Further, in internal therapy, since chlorides form insolu- 
ble compounds, these newer bodies have been made to avoid this 
chemical change. Among the more important of these may be 
mentioned : Argentol, argonin, argentamin, protargol, largin, actol, 
itrol, ichthyargon, and colloidal silver (collargolum). 

Argentol. — This is a synthetic compound of quinaseptol and silver, which breaks 
up into oxychinolin and metallic silver. It is non -caustic, and is valuable in surgical 
wounds, skin affections, and has been employed in gonorrhea, but is not so valuable as 
protargol for this disease. 

Argonin. — Origin. — A soluble compound of Silver and Casein, first prepared by 
Rohmann and Liebreich. 

Description and Properties. — A dilute solution of this substance in water is opales- 
cent; opaque when concentrated, but immediately cleared by the addition of ammonia 
or carbonate of soda. Used externally and locally. 

Physiological Action and Therapeutics. — Argonin is a very powerful, non-irritating 
germicide. The addition of a little ammonia to a solution of argonin vastly increases 
its bactericidal power, but deprives the drug of its bland, non-irritating character. It 
appears to lack astringent properties, and concentrated solutions are neither corrosive 
nor irritant. 

From experimental research Meyer concludes that argonin has a strong disinfecting 
influence upon certain bacteria, particularly the gonococcus, investigation having shown 
that a 1 : 30,000 solution of ammoniacal argonin completely suspended the growth of 
this microbe for five minutes. 

Judassohn, who has had an extensive experience with argonin in the treatment of 
gonorrhea, draws the following conclusions : (1) 1.5 to 2 per cent, solutions exert a rap- 
idly destructive action upon gonococci. (2) Strong solutions are devoid of inflammatory 
or corrosive action, and are consequently adapted to the treatment of acute gonorrhea 
of the anterior and posterior urethra in men, and of the uterus and urethra in women. 
(3) It appears to lack astringent properties, so that purely anticatarrhal treatment will 
indicate the assistance of other remedies. 

Argentamine. — In order that a deeper action of silver might result, this solu- 
tion of silver phosphate in aqueous solution of ethylendiamine was prepared. It was 



/72 A TEXT-BOOK OF MA TERIA MEDICA. 

found, however, that the amine was too irritating, and this preparation has but limited 
application. 

Protargol. — This product is the result of the attempt to obtain a compound of 
silver with an organic substance, albumose, which should be soluble and unirritating, 
and yet have the strong bactericidal properties of the metallic silver. It is a yellow 
powder, readily soluble in water, and contains 8.3 per cent, of silver. The solution is 
not affected by heat, albumin, hydrochloric acid, sodium chloride, or caustic soda. It 
is but slightly irritating, and has proved one of the best agents in the treatment of 
gonorrhea yet given to the profession. It is employed in from 2 to 10 per cent, 
solutions, depending upon the irritability of the affected parts and the stage of the 
disease. 1 

Largin. — This is a compound of much the same character as protargol, being silver 
combined with protalbin (Danilewsky), a paranuclein proteid prepared by Lilienfeld. 
This proteid combination is a gray powder, soluble in 9 parts of water, contains 11.1 per 
cent, of silver, and is not precipitated by chlorides nor by albumin. It is used in much 
the same manner as protargol, but has not been used so extensively as the former. It 
is used in \-2. per cent, solutions. 

Actol. — This is lactate of silver, a white powder, odorless, tasteless, and soluble in 
20 parts of water. It has been recommended as an antiseptic, and fulfills much the 
same indications that silver nitrate does. 

Itrol. — This is similar to actol, being the citrate of silver. It is much less soluble in 
water — 1-4000. It has no advantages over the nitrate. 

Ichthyargon is a combination of silver and ichthyol. Its position in therapy is not 
yet established. 

Colloidal Silver (Collargolum). — Finely divided metallic silver was introduced by 
Crede as an antiseptic in 1898. By the process of trituration metallic silver is converted 
into a soluble form, making, with water, a brownish solution. In this form it is used in 
internal hypodermic medication — £-1 per cent. (10-30 m.) — or the colloidal silver is 
made up as an ointment: 

R. Arg. colloid., ^iv (150 Gm.) ; 

Aq. dest., g\\ (5.0 Gm.); 

Cerse albae, ^iiss (10.0 Gm.) ; 

Adeps benzoinatis, E™ ss (7°-° Gm.). 

Simpler ointments may be made up with vaseline or lanoline, this latter making one 
of the best bases. 

The ointment should be rubbed into a part for from twenty to thirty minutes, and has 
been highly praised for the treatment of lymphangitis, adenitis, boils, septicemia, erysip- 
elas, puerperal fever, or other septic process, local or general. Failure to obtain results 
is said by its supporters to be due to insufficient rubbing. 

For internal medication for sepsis and erysipelas pills of colloidal silver are composed 
of the following : 

R . Arg. colloid, gr. vij (0.5 Gm.) ; 

Sacch. lactis, gr. lxxv (5.0 Gm.). 

Glycerini, 

Aq. dest., q. S. 
Fiat pilulse No. 50. Two pills, two or three times a day at meals. 

1 For a complete summary of the treatment of this disease by the newer silver prepa- 
rations see Medical News, May 18, 1901. 



ASTRINGENTS. 773 

Colloidal silver may be administered internally with food as follows : 

R. Arg. colloid., 0.5-2.0; 

Aq. dest., 50.0-200.0; 

Alb. ovi recent., 

Glycerini, aa 0.5-2.0. 

One teaspoon or dessertspoonful three times a day with a glass of water or cup of 
tea one-fourth to one-half hour before eating. 

Much more extended observation is desirable before trustworthy conclusions may 
be drawn concerning the value of colloidal silver. It is desirable that the ointment be 
freshly made. 

Alumen— AlGminis— Alum. U. S. P. 

Origin. — Prepared by a complicated process from a mixture of 
Aluminum Silicate and Iron Sulphide by roasting, lixiviating with 
water, concentrating the solution, and, while hot, mixing with Po- 
tassium Chloride. Upon cooling the alum separates as a crystal- 
line powder, which is purified by one or two recrystallizations. 

Description and Properties. — Large, colorless, octahedral crys- 
tals, sometimes modified by cubes, or crystalline fragments, without 
odor, but having a sweetish and strongly astringent taste. On 
exposure to the air the crystals are liable to absorb ammonia and 
acquire a whitish coating. Soluble in 9 parts of water and 0.3 part 
of boiling water ; also freely soluble in warm glycerin. Insoluble 
in alcohol. 

Dose. — 5-40 grains (0.3-2.60 Gm.) ; as an emetic, 1-2 drachms 
(4.0-8.0 Gm.). 

Official Preparation. 

Alumen Exsiccatum — Aluminis Exsiccati — Dried Alum (Burnt Alum). — 
Origin. — Alum heated until it is deprived of its water of crystallization. 

Description and Properties. — A white, granular powder, without odor, possessing a 
sweetish, astringent taste and attracting moisture from the air. Very slowly but com- 
pletely soluble in 20 parts of water, and quickly soluble in 0.7 part of boiling water. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Unofficial Preparation. 

Aluminis Glyceritum— Aluminis Glyceriti— Glycerite of Alum (20 per cent. 

alum). — Used externally. 

Allied Compounds. 

Alumnol— Alumnol— Alumnol.— Origin.— This substance was discovered by 
Filehne of Breslau, and is a mixture of Aluminum Salts of Naphthol-sulphonic Acid, 
containing about 5 per cent, of aluminum and 15 per cent, of sulphur. 

Description and Properties. — It occurs as a light, odorless, white or reddish-white, 



774 A TEXT-BOOK OF MATERIA MEDICA. 

non-hygroscopic powder. It possesses a sweetish and astringent taste, and is readily 
soluble in water or glycerin, less so in alcohol, and insoluble in ether. 

While becoming darker on exposure to the air, its properties are unaffected. Used 
externally and locally. 

Aluminum Aceto-tartrate. — Origin. — First prepared by Athenstadt by dissolving 
5 parts of Basic Aluminum Acetate in a sufficient quantity of water by the aid of 2 parts 
of Tartaric Acid, and evaporating the solution to dryness. 

Description and Properties. — It occurs in shining, almost colorless, amorphous 
masses, with a faint, acetous odor and an acidulous astringent taste. Soluble in water ; 
insoluble in alcohol. Used externally and locally. 

Aluminum Boroformate. — Origin. — Prepared by heating together Boric Acid, 
Formic Acid, and Alumina, 

Other combinations of aluminum are : Alsol (acetate), Boral 
(borotartrate), Cutol (borotannate), Gallal (gallate), Salwnin (sali- 
cylate), and Tannal (tannate). They have the same indications 
as alumnol. 

Antagonists and Incompatibles. — The alkalies and their car- 
bonates ; lead, mercury, and iron salts ; tartrates and tannic acid. 

Synergists. — The vegetable and mineral astringents. 

Alumini Hydras— Alum ini Hydratis— Aluminum 
Hydrate. U.S. P. 

Origin. — This substance is found in nature as the rare crystal- 
line mineral gibbsite of North America — the diaspore of Eastern 
Europe. The aluminum hydrate may be prepared by precipitating 
the solution of an aluminum salt with an alkali or alkali carbonate. 

Description and Properties. — A white, light, amorphous pow- 
der, odorless and tasteless, permanent in dry air. Insoluble in 
water or alcohol, but 'completely soluble in hydrochloric or sul- 
phuric acid, and also in potassium or sodium hydrate T. S. 

Dose. — 3-6 grains (0.2-0.4 Gm.). 

Alumini Sulphas— Alumini Sulphatis— Aluminum 
Sulphate. U. S. J>. 

Origin. — It is occasionally found as an efflorescence near vol- 
canoes and upon alum-slate. For medicinal use it should be pre- 
pared from Aluminum Hydrioxide, by dissolving it in the requisite 
quantity of Dilute Sulphuric Acid. 

Description and Properties. — A white, crystalline powder, 
having a sweetish and afterward astringent taste ; permanent in the 
air. Soluble in 1.2 parts of water, and much more freely in boiling 
water; insoluble in alcohol. Used externally. 



ASTRINGENTS. ■ 775 

Description and Properties. — -It occurs in pearl-like crystals 
or crystalline scales, which are veiy soluble in water. It contains 
33.5 per cent, of alumina. Used externally and locally. 

Sozal. — Origin. — Obtained by dissolving Aluminum Hydrate in Phenol-sulphonic 
Acid. 

Description and Properties. — A crystalline substance having an astringent taste and 
a faint odor of carbolic acid. It is freely soluble in water, glycerin, and alcohol. Used 
externally and locally. 

Physiological Action. — Externally and Locally. — Alum con- 
tracts the small blood-vessels and coagulates the albumin in the 
tissues, but in order to have any effect it must be applied to a 
denuded surface. It is also mildly escharotic. Applied to the 
unbroken skin, it thickens and hardens it. 

Internally. — Digestive System. — Its first effect when taken into 
the mouth is to excite the salivary secretion, the albumin in it, as 
well as that of the buccal mucous membrane, being precipitated. 
When its astringent action takes effect the secretions are dimin- 
ished and the mucous membrane of the mouth and tongue is 
blanched and puckered. The enamel of the teeth is affected, 
breaking under its influence. 

The digestive juices are diminished in quantity and the pepsin 
precipitated. Constipation follows, though it may be preceded by 
a slight diarrhea. 

Taken in large doses, alum produces nausea, vomiting, purging, 
and abdominal pain. 

Circulatory System. — Notwithstanding the fact that alum coag- 
ulates albumin, it is nevertheless absorbed into the blood-vessels, 
and by contracting them lessens all the secretions and arrests 
hemorrhage. When injected directly into the blood it produces 
thrombi and emboli. 

Nervous System. — Spasms are relieved by alum, but this action 
is in all probability dependent upon contraction of the blood- 
vessels. 

Absorption and Elimination. — As stated, alum is absorbed by 
the blood-vessels ; it is eliminated by the kidneys and liver. 

Untoward Action. — The prolonged use of alum is very apt to 
produce a cough in persons having sensitive bronchi. 

Therapeutics. — Externally and Locally. — Alum is used to de- 
stroy exuberant granulations and verrucosities. It is an excellent 
hemostatic in epistaxis and bleeding from the gums, vagina, rectum, 
bladder, bites, and sockets of extracted teeth. 



776 A TEXT-BOOK OF MATERIA MEDIC A. 

It is much used for sore throat by public speakers and singers, 
and is also efficient in tonsillitis, particularly the follicular form, 
gangrenous pharyngitis, stomatitis ulcerosa, relaxatio?i of the uvula 
and pharyngeal mucous membrane, swollen and overriding gums, 
and mercurial ptyalism. 

The destructive effect of alum upon the teeth must always be 
borne in mind : the alum stick or a swab is preferable whenever 
possible. If a mouth-wash or gargle be necessary, wash and brush 
the teeth well immediately after using the alum. 

Five grains (.32 Gm.) to 1 ounce (30.0 Cc.) of water is an excel- 
lent preparation for ophthalmia, conjunctivitis, and trachoma, but 
must not be used if there is any corneal inflammation, as it is apt 
to cause ulcers. By adding milk or white of egg to the mixture 
its efficiency is greatly increased. This preparation is also very 
serviceable in preventing the discoloration of a " black eye." An 
injection of 5-10 grains (.32-64 Gm.) to the ounce (30.0 Cc.) of 
water is much used in gonorrhea, leucorrhea, and gleet, and also 
for washing the vulva in pruritus. 

Sweating of feet, hands, and axillce, when excessive and fetid, is 
checked by the application of a lotion or powdered alum. 

Soaking a piece of cotton or lint with alum and placing it under 
an ingrowing toe-nail affords marked relief. 

Chilblains, old sores, and ulcers are also benefited by the use of 
alum. 

A spray, gargle, or insufflation has been used with good results 
in diphtheria, bronchorrhea, chronic laryngitis, aphonia due to atony, 
bronchitis, and whooping cough. 

Internally. — Alum operates advantageously as an astringent in 
arresting gastric and intestinal hemorrhages, hematuria, and menor- 
rhagia. The diarrheas of typhoid fever and chronic dysentery, and 
occasionally the acute forms, are strikingly benefited by an alum 
enema. 

It has been used in polyuria and diabetes mellitus, though in the 
later affection it is of little value. 

Although alum produces, it also relieves, constipation when 
flatus has existed for some time, and atony of the bowel diminished 
peristalsis. 

Given in emetic doses in membranous croup, it loosens the 
membrane, and as this is expelled it lessens the chance of another 
one forming by constringing the mucosa and blood-vessels, and 
thus preventing further exudation. 



ASTRINGENTS. yyy 

By checking absorption and producing emesis alum serves as an 
antidote for lead-poisoning t and is an efficient remedy in lead colic. 

Alumen exsiccatum is employed chiefly as an escharotic for 
fungous growths, and to stimulate indolent ulcers and mucous 
membranes with morbid secretions. 

Whenever the drug is used as a powder externally or for insuf- 
flation, powdered dried alum is the form to use. 

Administration. — The emetic dose of alum is 1-2 drachms 
(4.0-8.0 Gm.) in syrup. Warm water will increase its action when 
retching begins. 

For internal use, 5-10 grains (.32-64 Gm.), mixed with a little 
simple syrup or syrup of orange peel to prevent nausea, will be 
found beneficial. For collyria, 2-3 grains (.12-20 Gm.) in 1 ounce 
(30.0 Cc.) of water, or the alum curd, as already mentioned, may 
serve best. The curd may be separated by adding 2 drachms (8.0 
Gm.) of alum to 1 pint (473. Cc.) of milk, boiling, and straining. 

The gargle and injection can be used in strengths of 5-20 grains 
(.32-1.29 Gm.) to 1 drachm (4.0 Gm.). For insufflation the dried 
alum is employed. 



Bismuthi Citras— Bismuthi Citratis— Bismuth Ci- 
trate. V.S.I*. 

Origin. — Bismuth Subnitrate and Citric Acid are boiled in suf- 
ficient Water, and the precipitate washed and dried. 

Description and Properties. — A white, amorphous or micro- 
crystalline powder, odorless and tasteless, permanent in the air. 
Insoluble in water or alcohol, but soluble in ammonia water and in 
solutions of the citrates of the alkalies. 

Dose. — 1-3 grains (0.06-0.2 Gm.). 

Official Preparation. 

Bismuthi et Ammonii Citras— Bismuthi et Ammonii Citratis— Bismuth 
and Ammonium Citrate.— Origin.— Prepared by mixing Bismuth Citrate with Dis- 
tilled Water to make a paste, adding sufficient Ammonia Water to make a solution, filter- 
ing, evaporating, and drying on plates of glass. 

Description and Properties. .—Small, shining, pearly, or translucent scales, odorless, 
with a slightly acidulous and metallic taste, becoming opaque on exposure to the air. 
Very soluble in water, but sparingly soluble in alcohol. The product should be kepi in 
well-stoppered bottles, protected from light. 

Dose. — 1-10 grains (0.06-0.6 Gm.). 



778 A TEXT-BOOK OF MA TERIA MEDICA. 

Bismuthi Subcarbonas— Bismuthi Subcarbonatis— 
Bismuth Subcarbonate. TJ. S. I*. 

Origin. — Obtained by dissolving purified Bismuth in Nitric 
Acid and Water, decanting and filtering, mixing with Ammonia 
Water, washing the precipitate and dissolving in Nitric Acid. The 
solution is then mixed with a solution of Sodium Carbonate, and 
the resulting precipitate collected and washed. 

Description and. Properties. — A white or pale yellowish-white 
powder, of somewhat varying chemical composition, odorless and 
tasteless, permanent in the air. Insoluble in water or alcohol, but 
completely soluble in nitric or hydrochloric acid, with copious 
effervescence. 

Dose. — 5-20 grains (0.3-1.2 Gm.). 

Bismuthi SubnTtras— Bismuthi Subnitratis— Bis- 
muth Subnitrate. IT. S.I*. 

Origin. — Prepared by dissolving purified Bismuth in Nitric Acid 
and Water, concentrating by evaporation, adding more water, stir- 
ring well, and washing and drying the precipitated bismuth sub- 
nitrate. 

Description and Properties. — A heavy white powder, of some- 
what varying chemical composition, odorless and almost tasteless, 
permanent in the air. Nearly insoluble in water and insoluble in 
alcohol, but readily soluble in nitric or hydrochloric acid. 

Dose. — 5-20 grains (0.3-1.2 Gm.). 

Allied Compounds. 

Bismuthi Salicylas— Bismuthi Salicylatis— Bismuth Salicylate.— Dose, 1- 

20 grains (0.06-1.2 Gm.). 

Bismuthi Subiodidum — Bismuthi Subiodidi — Bismuth Subiodide. — Used 
externally. 

Bismuth Naphtholate. — Dose, 15-30 grains (1.0-2.0 Gm.). 

Bismuth Tribromphenate. — Dose, 60-75 grains (4.0-5.0 Gm.). 

Dermatol (Bismuth Subgallate). — Description and Properties. — A fine saffron- 
yellow powder, odorless, non-hygroscopic, unaffected by exposure to air or light, insoluble 
in water, alcohol, or ether. 

Dose. — 15-30 grains (1.0-2.0 Gm). 

Dermol (Bismuth Chrysophanate). — Description and Properties. — An amor- 
phous yellow powder, neutral in reaction, insoluble in water or alcohol. Used externally 
and locally. 

ThToform. — A combination of Bismuth, Sulphur, and Salicylic Acid. 
Description and Properties. — A light, grayish -yellow powder, odorless and tasteless, 
insoluble in water, alcohol, or ether. Used externally and locally. 



AS TRINGENTS. jj< } 

Xeroform. — Tribromphenolate of bismuth, containing 50 per cent, of Bi a O s . It is a 
yellow, neutral, insoluble powder, tasteless, odorless, and non-irritating. It is used in 
doses of 8-15 grains (0.5-I.O gm.) as an intestinal antiseptic. It is useful in fresh 
wounds, in gynecology, and in eczemas and prurigo. 

Orphal. — Beta-naphthol bismuth, containing 7 per cent, of oxide of bismuth and 23 
per cent, of beta-naphthol. It is a light-brown powder of pleasant taste, and splits up 
in the intestines into bismuth and beta-naphthol. It is used as an intestinal antiseptic 
in doses of 8-45 grains (0.5-3.0 Gm.). 

Eudoxin. — This is a bismuth salt of nosophan (q. v.). It is used in the same way 
as xeroform. There is a long list of other bismuth combinations, some of which may 
be found, after further observation, to be of service. 

Antagonists and Incompatibles. — The salts of bismuth are 
insoluble, and should not be prescribed with other agents in 
solution. 

Synergists. — The sedative action of bismuth upon the stomach 
may be increased by calomel and cerium oxalate, and pepsin may 
be given as a substitute for this purpose. The astringency of the 
bismuth salts may be enhanced by opium and tannic acid. 

Physiological Action. — Externally. — Bismuth salts are mildly 
astringent, but have no effect upon the unbroken skin. 

Internally. — Digestive System. — Bismuth is insoluble in the 
gastro-intestinal juices. It coats the mucous membrane, lessening 
secretions and absorbing excess of free acids, at the same time act- 
ing as a sedative and feeble astringent. The tongue and stools are 
tinged a dark clay color, due to conversion into the sulphide. The 
soluble salts are absorbed very slowly, and increase the appetite 
and digestion, constipation being the result. 

Circulatory System. — A minute quantity passes into the blood, 
acting as a tonic. 

Nervous System. — Bismuth salts are sedative to the peripheral 
nerve-endings. 

Absorption and Elimination. — The salts of bismuth are absorbed 
into the circulation, and are eliminated by the urine, liver, and feces. 

Untoward Action. — Odier noticed nausea, and Weenesk vomit- 
ing, colicky pains, diarrhea, or constipation, headache, sensation of 
heat, dizziness, and general debility. 

Poisoning. — It has always been assumed that cases of poisoning 
are due to the lead and arsenic contained in the bismuth prepara- 
tions, but Carnot and Riche found these metals present in such 
quantities as to be practically inert. 

The symptoms are similar to those of lead-poisoning. Large 
concretions may be found in the intestines, and sloughs in the 



780 A TEXT-BOOK OF MA TERIA MED. CA. 

mouth and gastro-intestinal canal may be present, as well as 
desquamative nephritis and albuminuria. 

Treatment of Poisoning. — Lavage, demulcents, and chemical anti- 
dotes for arsenic, magnesium, and calcium ; best of all, freshly 
precipitated hydrated oxide of iron. 

Therapeutics. — Externally and Locally. — Bismuth subnitrate 
is serviceable in ijitertrigo, erythema, acne rosacea, as a protective 
dressing for wounds, idcers, and epithelioma, and as an application 
for chapped nipples and hands, relieving the smarting and itching. 
It is also of use in fissure, prolapsus ani, and superficial burns. 

It is used as an injection in gonorrhea, leucorrhea, and ozena, 
and was formerly used as an insufflation in acute nasal catarrh, 
being abandoned because of the arsenic which it sometimes con- 
tains. It serves as a wash in aphthous stomatitis, mild cases of 
mercurial salivation, and cancrum oris, as well as for the fetid 
sweating of feet and other parts, and for chancres and phlegmonous 
erysipelas. It has also proved beneficial in chronic conjunctivitis 
and granular lids or trachoma. 

Internally. — It allays irritation, and is consequently useful in 
irritative vomiting and diarrhea. Gastric pain is relieved by it. 
It is valuable in pyrosis, chronic diarrhea, gastric ulcer, chronic 
dysentery, diarrhea of typhoid, early stages of cholera and cholera 
infantum, and in the gastritis due to alcohol. 

The citrate of bismuth and ammonium is very soluble, and 
should be used only for local applications. 

The oxide is insoluble, and combined with morphine has been 
used as a snuff in ozena and nasal catarrh. 

Subcarbonate of bismuth is not used in medicine. 

Salicylate of bismuth reduces the pulse and temperature in 
typhoid fever, and also corrects the fetid stools. 

Bismuth subgallate, or dermatol, was first used by Heintz 
and Liebrecht, being intended as a substitute for iodoform ; but it 
is very astringent, although not irritating. The preparation is used 
in weeping eczema, otitis media, herpes, wounds, burns, diarrhea, and 
dysentery. In stagnant ulcers it is of no service, since they need 
stimulation. 

Bismuth citrate is insoluble, and is of no service medicinally. 

Besides the foregoing preparations there is a tannate of bis- 
muth, used to some extent in diarrhea, gonorrhea, leucorrhea, and 
ophthalmia. 

Phosphate of bismuth is the least soluble of all the bismuth 



ASTRINGENTS. 781 

compounds, and is used, but rarely, in diarrhea, dysentery, gastral- 
gia, and dyspepsia. 

Subiodide of bismuth is used as a substitute for the subnitrate, 
and is of special value in chronic ulcers. It is supposed to be 
slightly anesthetic. 

Valerianate of bismuth is of no medicinal value. 

Subbenzoate of bismuth is mildly escharotic. 

Administration. — The drug is used externally as a powder or 
ointment in combination with naphthalin or vaseline, to which a 
little morphine may be added. Belladonna, opium, and oleate of 
bismuth are also used. 

For gastralgia and dyspepsia, pepsin or magnesium and calcium 
phosphate may be combined with bismuth. If a cathartic is desir- 
able, rhubarb may be added. 

Bismuth, aromatic powder, and carbo ligni make an excellent 
combination in flatulent dyspepsia. 

In infantile diarrhea and summer complaint bismuth 1 grain 
(.06 Gm.), syrupus aurantii 15 minims (.92 Cc), and calumba 15 
minims (.92 Cc.) are efficacious, particularly as they allay the 
alternating pain. 

Bismuth, 5-15 grains (.32-1.0 Gm.), is given for stomach affec- 
tions, and 15 grains (1.0 Gm.) to 1 drachm (4.0 Gm.) for intestinal 
disorders, one to two hours after meals as the stomach is emptied. 

Cerii Oxalas— Cerii Oxalatis— Cerium Oxalate. 

U. S. JP. 

(Cerous Oxalate.) 

Origin. — Prepared by a complicated process by the action of 
acids, etc. upon the powdered mineral. 

Description and Properties. — A white, granular powder, with- 
out odor or taste, and permanent in the air. Insoluble in water, 
alcohol, or ether. 

Dose. — 1-8 grains (0.06-0.5 Gm.). 

Physiological Action. — The physiological action of this drug 
is imperfectly understood : it is supposed to be a nervous and 
gastric sedative. 

Therapeutics. — Internally. — Its widest application is in the vom- 
iting of pregnancy, but it also controls the emesis of uterine disease 
and of dyspepsia, due to gastric acidity or deranged innervation of 
the stomach, as in sea-sickness. 



782 A TEXT-BOOK OF MATERIA MEDICA. 

It does not derange digestion, and is therefore of value in 
checking the cough of phthisis and bronchitis, especially when 
accompanied by vomiting. 

Simpson regarded it as almost a specific in chorea. In combi- 
nation with bismuth it is useful in checking diarrhea. 

Administration. — Cerium oxalate is usually administered in pill 
form, 1-3 grains (.06-20 Gm.) three times daily, but the powder 
is used when the drug is associated with other remedies. 



TOPICAL REMEDIES. 

Rubefacients, Vesicants, and Bscharotics. — These con- 
sist of a series of remedies that act directly upon the skin or 
mucous membrane,and are known by different names according to 
the amount of irritation produced. Rubefacients, as the mildest, 
cause a redness of the skin with dilated blood-vessels ; if their 
action is continued, local extravasation of serum beneath the epi- 
dermis may take place, forming a blister. If their action is more 
severe or if long continued, death of tissue may take place, thus 
causing a cauterizant action with the formation of an eschar. 
Emollients and demulcents have an opposite effect in that they 
tend to allay or prevent irritative reactions on the part of the skin 
(emollients) or mucous membranes (demulcents). 

GROUP XVIII.— RUBEFACIENTS. 

These are drugs which, when locally applied, are intended to 
produce temporary redness and congestion of the skin. Some 
of them are vesicant if applied in full strength, and if their contact 
with the skin be sufficiently prolonged, vesication, or even total 
destruction of tissue, may result. 

The following list embraces the principal rubefacient drugs : 

Ammonia, Menthol, 

Alcohol, Mezereon, 

Arnica, Mustard, 

Camphor, Oil of Cajuput, 

Capsicum, Oil of Turpentine, 

Chloroform, Pitch, 

Ether, Volatile Oils. 
Iodine, 
Hot water and friction are also rubefacient agents. 

Rubefacients are used for their influence upon the skin itself 
or for their effect on deep-seated structures. 

Rubefacients are efficient means of relieving neuralgic pains, 
conditions of nervous debility, nervous excitement, the sense of 
fatigue, and as an aid in narcotic poisoning, also to hasten the 

783 



784 A TEXT-BOOK OF MATERIA MEDICA. 

absorption of iiiflai amatory exudates, to remove the swelling and 
restore the function of chronically inflamed joints, etc. 

Rubefacients should ordinarily be applied with friction, as rub- 
bing of the skin aids the action of many of them. 

Save one, all the rubefacients mentioned in the preceding list 
have been considered elsewhere in the present work. 

PTx Burgundica— PIcis Burgundicae— Burgundy 
Pitch. U.S.JP. 

Origin. — The prepared resinous preparation of Abies excelsa 
Poiret, the spruce fir, or Norway spruce, a stately tree growing 
in Northern Asia and Northern Europe, and frequently cultivated 
in the United States. 

Description and Properties. — Hard, yet gradually taking the 
form of the vessel in which it is kept, brittle, with a shining, con- 
choidal fracture, opaque or translucent, reddish-brown or yellowish- 
brown ; odor agreeably terebinthinate ; taste aromatic, sweetish, 
not bitter. It is almost entirely soluble in glacial acetic acid or in 
boiling alcohol, and partly soluble in cold alcohol. 

Burgundy pitch contains a resin and a volatile oil in variable 
proportion. 

Used externally. 

Official Preparations. 

Empiastrum PIcis Burgtindicae — Empl&stri PIcis Burgiindicae — Burgundy 
Pitch Plaster. — Contains 90 per cent, of Burgundy Pitch. Used externally. 

Emplatstrum PIcis Canthasridatum — Emplatstri PIcis Cantharidati — Can- 
tharidal Pitch Plaster (Warming Plaster). — Contains 8 per cent, of Cerate of 
Cantharides. Used externally. 

Burgundy Pitch is contained in Emplatstrum Ferri and Emplalstrum Opii. 

Physiological Action and Therapeutics. — Burgundy pitch 
when applied to the skin in the form of a plaster occasions red- 
ness and a papular eruption, accompanied by itching. If the plaster 
is allowed to remain in contact with a delicate skin for too long 
a period, there may be produced a vesicular or even pustular 
eruption. 

The chief uses of Burgundy pitch plaster are to protect, sustain, 
or stimulate the part to which it is applied. 

The plaster is an efficient remedy in subacute and chronic 
pleurisy, chronic bronchitis, lumbago, muscular rheumatism, etc. 

Before applying a Burgundy pitch plaster to a hairy skin, the 
hair should be shaved off. The removal of the plaster may be 



VESICANTS AND EPISPASTICS. 785 

facilitated by warming it, applying to the back of the plaster a hot 
bottle or hot water-bag. Any particles of pitch which may adhere 
to the surface of the skin may be removed by washing with warm 
alcohol. 



GROUP XIX.— VESICANTS AND EPISPASTICS. 

These are drugs which excite more or less local inflammation 
when applied to the skin ; the inflammatory condition is accom- 
panied by an effusion of serum between the epidermis and dermis — 
i. e. a blister. 

The principal Vesicants are — 

Acetic Acid (glacial), Mezereon, 

Ammonia (the confined vapor), Mustard (volatile oil), 

Cantharides, Rhus Toxicodendron. 
Iodine, 

There are certain drugs which affect certain parts of the skin — 
for instance, the orifices of the sudoriferous glands — in a special 
manner, and their action on these parts is such as to give rise to 
pustules rather than blisters. Drugs which affect the skin in this 
manner are called Pustulants. The following-named drugs are 
the most important of them : 

Croton Oil, Silver Nitrate, 

Tartar Emetic, Ipecac. 

Therapeutics. — Vesicants are employed as local stimulants in 
chronic ulcers and to facilitate the absorption of effusions, as in 
chronic synovitis or chronic thickening about the joints. 

Blisters are also of use in endocarditis, neuralgias, sciatica, clironic 
pericarditis, pleurisy, hysterical paralysis, and aphonia, cerebral or 
spinal meningitis, etc. 

Pustulants are more particularly employed to maintain a con- 
tinuous though moderate irritation in chronic inflammations. They 
are but rarely used for the same class of cases as vesicants, but are 
preferable when it is desirable to prolong the local irritation with- 
out exciting too much inflammation. 

Contraindications. — Vesicants are usually contraindicated in 
acute inflammations and in inflammation of the cutaneous tissues, 
as rubeola and scarlatina. Vesicants are not permissible in preg- 
nancy, debility, scorbutus, and purpura, or in extreme infancy and 
old age. They should not be applied over the scrotum or the 

50 



786 A TEXT-BOOK OF MATERIA MEDIC A. 

mammary glands, nor over bony prominences where the healing 
processes are apt to be retarded. 

All the vesicants and pustulants have, with two exceptions, been 
discussed elsewhere. 

Cantharis— Cantharidis— Cantharides. TT. 8. JP. 

(Spanish Flies.) 

Origin. — Cantharis vesicatoria De Geer, a beetle indigenous to 
Southern and Central Europe, and found eastward as far as West- 
ern Asia. 

Description and Properties. — About I inch (25 Mm.) long and 
\ inch (6 Mm.) broad ; flattish-cylindrical, with filiform antennae, 
black in the upper part, and with long wing-cases and ample, 
membranous, transparent, brownish wings, elsewhere of a shining, 
coppery-green color. The powder is grayish-brown, and contains 
green shining particles. Odor strong and disagreeable ; taste slight, 
afterward acrid. 

Cantharides contains a fatty crystallizable body, cantharidin, 
which is the active principle, a volatile oil also possessing vesica- 
tory properties, and a green oil closely allied to chlorophyl. 

Used externally. 

Official Preparations. 

Ceratum Cantharidis — Cerati Cantharidis — Cantharides Cerate. — Cantha- 
Tides, 320; Yellow Wax, 180; Resin, 180; Lard, 220; Oil of Turpentine, 150. — Used 
externally. 

Collddium Cantharidatum — Collodii Cantharidati — Cantharidal Collodion 
^Blistering Collodion). — Used externally. 

Tinctiira Canth&ridis — Tinctiirae Cantharidis — Tincture of Cantharides. — 
Dose, 1— 15 minims (0.06-1.0 Cc.). 

The Cantharides Cerate is an ingredient of Emplastrum Picis Cantharidatum. 

Antagonists and Incompatibles. — There are no known physi- 
ological antagonists or incompatibles. 

Synergists. — Members of this group enhance the vesicating 
action of cantharides. Its aphrodisiac action is aided by phos- 
phorus and strychnine. 

Physiological Action. — Externally and Locally. — Cantharides 
is a slow though very powerful irritant. When the drug is applied 
to the skin or mucous membrane it excites a tingling, burning pain, 
with marked redness of the cuticle. In the course of three or four 
hours after the application of cantharides there are formed numer- 



VESICANTS AND EPISPASTICS. 787 

ous vesicles which soon coalesce, forming one large bleb full of 
clear serum. 

The drug not only causes vascular dilatation of the part to 
which it is applied, but reflexly dilates the blood-vessels of the 
deep-seated organs underneath, thus acting as a counter-irritant. 

The active principle of cantharides may be absorbed through 
the skin, producing its constitutional effects. 

Internally. — Digestive System. — Moderate doses of cantharides 
produce a sensation of heat in the stomach, and may even occasion 
gastrodynia. Large amounts occasion severe gastro-intestinal irri- 
tation. There is a sense of constriction in the esophagus, a burning 
heat in the throat, ptyalism, intense gastric pain, nausea, and vomit- 
ing of glairy mucus often containing blood. There is great tender- 
ness over the abdomen, fibrinous and sometimes bloody stools, 
attended by griping pain and tenesmus. 

Circulatory System. — Full medicinal doses excite the heart, 
increasing the force and rapidity of its action, and elevate arterial 
tension. Under large doses the pulse and arterial pressure fall, 
and there is great depression of the entire circulatory system. 

Nervous System. — Small doses have no influence on the nervous 
system other than would be produced by stimulation of the 
circulation. Excessive amounts have produced marked cerebral 
effects, consisting of partial or general convulsions, coma, and 
insensibility. 

Respiratory System. — No effect follows medicinal doses ; toxic 
amounts accelerate and weaken the respiration. 

Absorption and Elimination. — The active principle of cantharides 
is rapidly absorbed into the blood, and in large doses produces 
marked irritation of the genito-urinary organs. There is at first 
increase of urine, which is soon greatly diminished in amount, and 
which may be albuminous or bloody. There is strangury and fre- 
quent desire to micturate, and severe pain in the loins and bladder. 
The local irritation is apt to occasion priapism, with frequently 
erotic excitement and seminal emissions. There may also be 
swelling and inflammation of the external genitals. In women 
cantharides may also occasion increased sexual desire, cause abor- 
tion, or induce menstruation. Yet amatory desire does not always 
follow the ingestion of cantharides, even in large doses. Indeed, 
the aphrodisiac effect of the drug is usually more manifest under 
small or full medicinal doses than from the ingestion of immoderate 
amounts. The drug is principally eliminated by the kidneys. 



A TEXT-BOOK OF MATERIA MEDIC A. 



-The temperature is at first elevated by excessive 
amounts, but declines together with the depression of the circu- 
latory system. 

Uterus. — The uterus and female genital organs are stimulated by 
the drug, as has been previously described. 

Untoward Action. — The untoward manifestations do not differ 
from the symptoms produced by excessive amounts, as described 
under the different systems. These various untoward effects vary 
in intensity according to the individuality of the patient. 

Poisoning. — Toxic amounts of cantharides produce violent gastro- 
intestinal and genito-urinary inflammation. The general symptoms 
are great pain in the throat, stomach, and bowels, excessive thirst, 
vomiting of bloody mucus, frequent stools which may contain blood, 
burning pain in the kidneys, strangury, scanty, albuminous, and 
bloody urine, painful erections of the penis, seminal emissions, swell- 
ing and inflammation of the external genitals, a rapid, small, and 
weak pulse, accelerated respiration, skin hot and dry, congestion of 
the face, pain in the head, delirium, trembling, partial or general 
convulsions, and coma. The post-mortem appearances are swell- 
ing, ecchymoses, and sometimes gangrene of the mucous mem- 
brane of the alimentary canal. The kidneys are enlarged and 
engorged, and are in a condition of parenchymatous and desquam- 
ative nephritis. 

Treatment of Poisoning. — The stomach should be emptied, and 
demulcents, stimulants, and opiates given as necessary. Oils and 
fats should be avoided, as they increase the solubility and favor the 
absorption of cantharidin. 

Therapeutics. — Externally and Locally. — A cantharidal blis- 
ter is frequently of service as a revulsive when there is a local tend- 
ency to congestion. The drug is applied to the chest in the second 
stage of pneumonia and in pleurisy, and " flying " blisters are 
beneficial in hydrothorax and chronic pleurisy. 

The cure of boils and carb?mcles has been hastened by applying 
a cantharidal blister to the indurated spot. 

The drug is also of service to stimulate indolent ulcers, fistulas, 
etc. 

A blister over the region of the heart will often afford marked 
relief in pericarditis. 

A cantharidal plaster applied over the course of the affected 
nerve frequently affords great relief from pain in neuralgia and 
some forms of sciatica. 



VESICANTS AND EPISPASTICS. 789 

In subacute or chronic inflammatory diseases of the brain and 
spinal cord, such as meningitis, blisters applied to the nape of the 
neck or along the course of the cord, a little to one side of the 
vertebrae, will often favorably influence the course of the disease. 

Blisters are frequently of service in synovitis and periostitis of 
the larger bones. A blister applied to the epigastrium will some- 
times allay gastric pain and obstinate vomiting. 

Blistering over the region of the ovary is an efficient means of 
relieving the symptoms of chronic ovaritis, and a blister applied to 
the mastoid region will frequently be of benefit in otitis media. 

Small patches of tinea tonsurans and of tinea circinata may be 
removed by blistering. 

Liniments and lotions containing tincture of cantharides are 
among the best means of curing alopecia. 

Internally. — Certain diseases of the genito-urinary organs, as 
debility of the bladder with accompanying incontinence of urine, 
chronic pyelitis, chronic catarrh of the bladder, etc., are benefited 
by small doses of tincture of cantharides. 

Gleet, prostatorrhea, and spermatorrhea are benefited by this 
drug. Menorrhagia and amenorrhea occurring in debilitated women 
will often be benefited by cantharides. 

Tincture of cantharides, with tincture of iron, tincture of nux 
vomica, and phosphoric acid, is an efficient combination in impo- 
tence, the result of old age, sexual excesses, or masturbation. 

In scaly skin diseases cantharides often proves very serviceable 
after arsenic and the external application of tarry preparations have 
failed. 

Cantharidin and potassium cantharidate have been recom- 
mended by Professor Liebreich as efficient remedies in tuberculosis. 

Hypodermic injections not exceeding T J-g- grain (0.0006 Gm.) of 
cantharidin are used, and in some cases apparently have been 
followed by good results. The treatment, however, has not proved 
sufficiently successful to warrant its employment to the exclusion 
of other measures. 

Administration. — A cantharidal blister should not be allowed 
to remain on the skin for more than twelve or twenty-four hours, 
six to eight hours usually being sufficient. 

When blebs are formed, they should be carefully opened at 
their most dependent parts. When the serum has drained away 
the part should be dressed with a layer of borated cotton kept in 
place by the aid of a few strips of adhesive plaster. Should the 



790 A TEXT-BOOK OF MA TERIA MEDICA. 

blistering by cantharides occasion too great pain, a poultice made 
of breadcrumb and solution of subacetate of lead, to which is 
added \ or \ grain (0.008 or 0.0 1 Gm.) of morphine sulphate or 
other soothing application, should be applied to the blistered part. 
The obstinate ulcers which sometimes follow the use of cantharides 
blisters may be treated effectively by Goulard's cerate. 

It is said that the strangury which plasters of cantharides fre- 
quently cause may be prevented by sprinkling the surface of the 
plaster with powdered camphor or sodium bicarbonate. 

For internal use the tincture of cantharides is the only prepara- 
tion to employ. 

Sinapis Alba— Sinapis Albae— White Mustard. 

XT. S. JR. 

Origin. — The seed of Brassica alba L., Hooker filius et Thomp- 
son. 

Sinapis Nigra— Sinapis NTgrae— Black Mustard. 

U. S. JP. 

Origin. — The seed of Brassica nigra L., Koch. 

Both the white and black mustard are annual plants, indigenous 
in Southern Europe and Western Asia, cultivated, and sometimes 
found wild, in the United States. 

Description and Properties. — White mustard seeds are 
almost globular, about ^ mcn ( 2 Mm.) in diameter, with a circular 
hilum ; testa yellowish, finely pitted, hard ; embryo oily, with a 
curved radicle and two cotyledons, one folded over the other ; free 
from starch ; inodorous ; taste pungent and acrid. 

Black mustard seeds resemble the preceding in shape, but have 
a diameter only of -^ inch (1 Mm.); blackish-brown or deep red- 
dish-brown, with a testa covered with shallow pits, and when 
crushed and macerated with water acquiring a strong and pungent 
odor. 

White mustard seed contains an almost tasteless, yellowish, 
fixed oil, and a substance known as sinalbin, which is the chief con- 
stituent. This substance may be converted into sulphocyanate of 
acrinyl (the volatile oil of mustard) by the action of the ferment 
myrosin and water. Black mustard seeds contain the same fixed 
oil as the white mustard, and a glucosid, sinigrin, which by the 
action upon it of myrosin in contact with water converts it into 



VESICANTS AND EPISPASTICS. 791 

ally I sulphocyanide (a volatile oil). To this volatile oil of mustard, 
which is official, are due both the pungent taste and odor of the 
moistened powder. 

Dose. — 1-4 drachms (4.0-15.0 Gm.). 

Official Preparation {of Black Mustard Seed). 
Charta Sinapis — Chartae Sinapis — Mustard Paper. 

Oleum Sinapis Volatile— Olei Sinapis Volatilis— Vol- 
atile Oil of Mustard. U. S. J>. 

Origin. — A volatile oil obtained from Black Mustard by macera- 
tion with Water and subsequent distillation. 

Description and Properties. — A colorless or pale yellow, limpid, 
and strongly refractive liquid, having a very pungent and acrid odor 
and taste. Freely soluble in alcohol, ether, or carbon disulphide. 
Used externally. 

Official Preparation. 

LinimSntum Sinapis Compositum — LinimSnti Sinapis Compfisiti — Com- 
pound Liniment of Mustard. — Formula: Volatile Oil of Mustard, 30; Fluid Ex- 
tract of Mezereum, 200; Camphor, 60; Castor Oil, 150; Alcohol, to 1000, by solution. 
Used externally. 

Physiological Action. — Externally and Locally. — Mustard is 
irritant, counter-irritant, rubefacient, and vesicant. Any degree of 
irritation, from slight redness of the skin to severe blistering, may 
be produced by mustard. It is more rapid in its action than can- 
tharides, and when applied to the skin there is produced almost 
immediately a sensation of warmth, which rapidly passes into a 
severe burning pain. This irritation of the sensory nerves is suc- 
ceeded by paralysis and more or less loss of sensation, so that if 
mustard be allowed to remain on the skin until blistering ensues 
there is a decided 'diminution of pain. 

The local application of mustard reflexly stimulates the heart 
and respiration. 

Internally. — Mustard in small amounts is taken as a condiment, 
and is a powerful stimulant of the gastro-intestinal tract. Large 
doses irritate the stomach and act as an emetic, producing prompt 
emesis without depression, owing to the reflex stimulation of the 
heart and respiration. 

The volatile oil of mustard is never intentionally given inter- 
nally. It is a powerful caustic irritant, a single drop upon the 
tongue producing an intense burning pain in the throat, stomach, 
and nose. 



792 A TEXT-BOOK OF MATERIA MEDICA. 

Therapeutics. — Externally and Locally . — Mustard may be used 
locally for the same purposes as cantharides, being superior to the 
latter-named drug when a simple rubefacient effect is desired. 
Mustard when applied locally is more of a stimulant to the circu- 
latory and respiratory systems than cantharides, and is therefore an 
efficient remedy in syncope, asphyxia, and coma. 

As a stimulant in these conditions, a large mustard poultice is 
applied to the legs. 

A mustard bath, in the strength of i drachm (4.0 Gm.) to 1 
gallon (3785.43 Cc.) of water, is an efficient means of breaking up 
a cold, and if properly used is of service when the rash in measles 
or scarlet fever has receded. 

The menses may often be re-established when suppressed by a 
mustard sitz-bath, taken at the time of the expected period. 

Internally. — Other than the use of mustard as a condiment, the 
drug is given only to produce vomiting, being one of the best 
emetics in indigestion and narcotic poisonmg. 

Obstinate hiccough has sometimes been arrested by an infusion 

OF MUSTARD. 

Administration. — A mustard plaster, or sinapism, is prepared 
by mixing equal parts of wheaten or rye flour with water to the 
consistence of a thick paste, which is spread on linen or cotton 
cloth and applied to the skin. A dampened piece of gauze inter- 
posed between the plaster and the skin will prevent the former 
from adhering. 

A mustard cataplasm is a weaker preparation. A flaxseed or 
cornmeal poultice is made, to which a small quantity of ground 
mustard is added. This is intended to maintain a gentler but more 
prolonged action than the sinapism. 

" Mustard leaves," or plasters which may be obtained ready pre- 
pared at drug-stores, are intended to be simply dipped in water and 
applied to the skin. Their activity may be lessened by interposing 
a thin piece of linen or cotton cloth between the plaster and the 
skin. 

Liniments containing oil of mustard are efficient rubefacients, 
care being taken to adapt the strength of the preparation to the 
delicacy of the skin. 

When mustard is taken as an emetic, it is given in the form of 
an infusion, in the proportion f of I, 2, or 3 drachms (4.0, 8.0, or 
12.0 Gm.) to I pint (473.17 Cc.) of water. 

A preparation known as mustard whey is sometimes given. It 



CAUSTICS OR ESCHAROTICS. 793 

is prepared by boiling \\ ounces (46.65 Gm.) of bruised mustard 
seed in a mixture of 1 pint (473.17 Cc.) of milk and 1 quart 
(946.35 Cc.) of water, until it is curdled, when the whey should 
be strained off. 



GROUP XX.— CAUSTICS OR ESCHAROTICS. 

Caustics are medicines which destroy the tissues to which they 
are applied. They excite inflammation and vascular dilatation of 
the surrounding area. The eschar produced by these drugs is 
separated from the living tissues by the inflammation and sup- 
puration produced. 

The action of caustics is typically a chemical or physicochemical 
one. The layer of cells that may be destroyed varies in depth with 
the caustic employed, and the caustic used may cause a hard, 
smear-like, or fluid eschar, which; by demarcating inflammatory 
processes, is sooner or later thrown off. The caustics may be 
divided roughly into caustic acids, caustic alkalies, caustic metallic 
salts, and some few organic caustic compounds not readily classi- 
fied. In many of the acids and salts the action of the acid ion of the 
caustic causes oxidation and reducing processes. By many of the 
acids an acid albumin or syntonin is formed ; by the alkalies, an 
alkali albuminate ; and by the salts, metal albuminates are pro- 
duced. Many of these metal albuminates are permanent, in which 
case a characteristic hard and scaly eschar results. 

The character of the eschar is determined largely by the tissue 
involved: thus, by alkaline caustics, the keratin of the skin is dis- 
solved ; fatty substances are converted into soaps or soapy ma^ 
Many caustics have the power of being absorbed and of causing 
systemic poisoning. The salts of chromium, osmium, and arsenic 
are of importance in this connection. 

Many of the caustics cause extreme pain, and their use is 
gradually being abandoned for the more accurate methods of 
surgery. 

Caustics are employed for the following general purposes: 

1. In specific acute poisonous injuries, as from the bite of 
poisonous insects, reptiles, or other animals. The caustic is applied 
to the wound directly, in order to destroy the poison. Perman- 
ganate of potash, alkalies, or the direct cautery are the most 
reliable. 



794 A TEXT-BOOK OF MA TERIA MEDICA. 

2. To destroy new growths of microbial origin. In lupus, 
sarcoma, carcinoma, chancres, charbon, etc., nitric acid, alkalies, 
glacial acetic, etc., are most employed. 

3. To remove small tumors, warts, polypi, nasal or genital, 
hypertrophied mucous membranes. Here nitric and chromic acids, 
silver nitrate, etc., are of service. 

4. For depilatory purposes — removing hair, etc. 

5. To reduce and destroy inoperable tumors. Here the more 
caustic alkalies, arsenic, zinc, etc., have been widely employed in 
the past. 

6. To reduce flabby and exuberant granulations in wounds. 
Nitrate of silver is one of the best drugs. 

7. At times to influence deeper parts, in neuralgias and inflam- 
matory action in an internal organ, it is beneficial to employ a 
superficial escharotic. 

Those escharotics which have not been discussed elsewhere 
will now be considered in detail : 

Liquor Antimonii Chloridi— Liquoris Antimonii 
Chloridi— Solution of Antimony Chloride. (Unofficial.) 

(Butter of Antimony.) 

Origin. — Prepared by the action of Hydrochloric Acid upon 
Purified Black Antimony. 

Description and Properties. — A yellowish or yellowish-red 
liquid, having the specific gravity 1.47, and yielding with water a 
white precipitate of antimonious oxychloride (powder of Algarotli). 

Used externally as a caustic. 

Physiological Action and Therapeutics. — Solution of anti- 
mony chloride is one of the most powerful caustics employed in 
surgery. It is a violent corrosive poison, toxic doses producing 
complete general collapse, corroding and charring any living tissue 
with which it comes in contact. The treatment of poisoning by 
butter of antimony would be — -chalk, magnesia, demulcent drinks, 
tannic acid, anodynes, and stimulants if necessary. 

Solution of chloride of antimony may be used as a caustic 
for the bites of rabid animals and venomous reptiles , chancres, con- 
dylomata, malignant pustules, etc. 

The preparation should be cautiously applied with a camel's- 
hair pencil. 



CAUSTICS OR ESCHAROTICS. 795 

Acidum Chromicum— Acidi Chromici— Chromic 
Acid. U.S. P. 

(Chromic Trioxide; Chromic Anhydride.) 

Origin. — Dissolve Potassium Bichromate in Sulphuric Acid 
and Water ; decant, heat with more Sulphuric Acid ; cool, and 
crystallize. 

Description and Properties. — Small, needle-shaped crystals 
or rhombic prisms, of a dark purplish-red color and metallic 
luster ; odorless ; destructive of animal and vegetable tissues ; 
deliquescent in moist air. Very soluble in water, forming an 
orange-red solution. When brought in contact with alcohol, 
ether, glycerin, and other organic solvents decomposition takes 
place, sometimes with dangerous violence. Chromic acid should 
be kept in glass-stoppered bottles, and great caution should be 
observed to avoid bringing it in contact with organic substances, 
such as cork, tannic acid, sugar, alcohol, etc., as dangerous acci- 
dents are liable to result. Used externally. 

Physiological Action and Therapeutics. — Chromic acid is 
a powerful caustic, deodorant, and disinfectant. It coagulates 
albumin and oxidizes organic matter. Its action is slow, and the 
pain following its application is usually of shorter duration than 
that of most caustics. Weak solutions are stimulant, astringent, 
and alterative. 

Chromic acid is used in the form of a paste or in solutions of 
various strengths for the removal of syphilitic warts , vegetations, 
condylomata, etc. As a caustic and stimulant application in many 
diseases of ear, nose, and throat it serves a valuable purpose, as in 
nasal polypi, enlarged tonsils, chronic and syphilitic laryngitis, laryn- 
geal papillomata, chronic superficial glossitis, tuberculosis of the 
tongue, ozena, ulcerations of the mouth, etc. 

A 10 per cent, solution of chromic acid has been found service- 
able in the treatment of hyperidrosis. 

A solution of 1 part of chromic acid in 40 parts of water makes 
an efficient lotion for disinfecting foul ulcers and as an injection in 
gonorrhea, leucorrhea, etc. 

Sessile piles and salivary fistulce are efficiently treated by touch- 
ing the parts with pure chromic acid. 



796 A TEXT-BOOK OF MATERIA MEDICA. 

Potassa— Potassae— Potassa. U. S. I*. 

(Potassium Hydrate; Potassium Hydroxide; Caustic Potash.) 

Origin. — Prepared by evaporating Liquor Potassae, fusing the 
residue, and pouring into clean cylindrical moulds which have been 
previously warmed. 

Description and Properties. — Dry, white, translucent pencils, 
or fused masses, hard and brittle, showing a crystalline fracture ; 
odorless or having a faint odor of lye, and of a very acrid and 
caustic taste. Because of its active effect upon organic tissues it 
should be tasted and handled with exceeding care. Exposed to 
the air, it rapidly absorbs carbon dioxide and moisture, and 
deliquesces. Soluble in about 0.5 part of water and in 2 parts 
of alcohol. Potassa should be kept in well-stoppered bottles 
made of hard glass. Used externally. 

Potassa cum Calce— Potassae cum Calce— Potass^ 
with Lime. U. S. J\ 

(Vienna Caustic or Vienna Paste.) 

Origin. — Prepared by rubbing together equal parts of Potassa 
and Lime in a warm iron mortar. 

Description and Properties. — A grayish-white powder, deli- 
quescent, having a strongly alkaline reaction. Used externally. 

Soda— Sodae— Soda. XT. S. JP. 

(Sodium Hydrate; Sodium Hydroxide; Caustic Soda.) 

Origin. — Prepared from a solution of Soda in the same manner 
as described under Potassa. 

Description and Properties. — Dry, white, translucent pencils 
or fused masses, showing a crystalline fracture, odorless, and 
having an acrid and caustic taste. Great caution is necessary in 
tasting and handling it, as it rapidly destroys organic tissues. 
Exposed to the air, it rapidly deliquesces, absorbs carbon dioxide, 
and becomes covered with a dry coating of carbonate. Soluble in 
1.7 parts of water, very soluble in alcohol. Soda should be kept 
in well-stoppered bottles made of hard glass. Used externally. 

Physiological Action and Therapeutics. — Potassa is one of 
the strongest and most penetrating caustics known. It possesses 
the property of abstracting water from the tissues, neutralizing free 
acids, decomposing nitrogenous compounds, and of forming solu- 
tions of fibrin, albumin, and gelatin. 






CAUSTICS OR ESCHAROTICS. 797 

When applied to the soft tissues it occasions severe pain, and 
produces a moist, ashen, and then black, leathery slough, which 
leaves a granulating ulcer behind it. 

When potassa is taken internally in immoderate doses it pro- 
duces all the symptoms of corrosive poisoning. Small doses, freely 
diluted, have the same action as the alkalies. 

As a caustic, potassa is used for the same purposes as the caus- 
tics previously described. 

Potassa with lime in its operation is similar to, but milder 
than, potassa. 

The action and therapeutics of soda are identical with those of 
potassa, save that soda is less depressing to the heart, muscular 
and nervous systems. It is not used so much as potassa, the 
latter preparation usually being preferred as a caustic. 

To limit the caustic action of these drugs a piece of adhesive 
plaster should be applied first, with an aperture of the size desired. 
Upon the skin exposed in the hole in the plaster the caustic is 
placed, the skin having been previously moistened. The caustic 
action may be arrested at any time by wetting the part with vinegar. 

Acidum Aceticum Glaciale— Acidi Acetici Glacialis 
—Glacial Acetic Acid. U. S. P. 

Origin. — Prepared by distilling dry Sodium Acetate with strong 
Sulphuric Acid. 

Description and Properties. — A clear, colorless liquid, of a 
strong, vinegar-like odor, and a very pungent, purely acid taste. 
Its specific gravity at 15 C. (59 F.) should not be higher than 
1.058, corresponding to at least 99 per cent, of absolute acid. 
Used externally. 

Physiological Action and Therapeutics. — Glacial acetic acid is 
a powerful corrosive poison, having an action similar to that of the 
mineral acids. The drug is principally used as a caustic for the 
removal of warts and corns, and occasionally for blistering the skin. 

Calx— Calcis— Lime. U. S. B. 

Origin. — Obtained by burning White Marble, Oyster Shells, or 
the purest varieties of natural Calcium Carbonate. 

Description and Properties.— Hard, white or grayish-white 
masses, which, in contact with air, gradually attract moisture and 
carbon dioxide, and fall to a white powder ; odorless ; of a sharp, 



798 A TEXT-BOOK OF MATERIA MEDICA. 

caustic taste. Soluble in about 750 parts of water; insoluble in 
alcohol. Used externally. 

Physiological Action and Therapeutics. — Quicklime when 
used undiluted is caustic, producing effects similar to those de- 
scribed under Potassa. 

For caustic purposes it is usually mixed with potassa (potassa 
cum cake). When lime is given in diluted solution, it acts as an 
astringent and antacid. (See Liquor Calcis, p. 168.) 

The conditions for which lime is employed as a caustic are men- 
tioned under Potassa. 

ZTnci Chloridum— Zinci Chloridi— Zinc Chloride. 

77. 8. P. 

Origin. — Prepared by dissolving Zinc in boiling Hydrochloric 
Acid. To the solution is added first Nitric Acid, then Zinc Car- 
bonate to precipitate the impurities. Filter and finally evaporate. 

Description and Properties. — A white, granular powder or 
porcelain-like masses, irregular or moulded into pencils ; odorless ; 
of such intensely caustic properties as to make tasting dangerous, 
unless the salt be dissolved in much water, when it has an astrin- 
gent, metallic taste. Very deliquescent ; soluble in about 0.3 part 
of water, forming a clear solution ; very soluble in alcohol. Zinc 
chloride should be kept in small, glass-stoppered bottles. 

Used externally. 

Physiological Action and Therapeutics. — Zinc chloride is 
caustic, antiseptic, disinfectant, excitant, astringent, and slightly 
hemostatic, according to the strength of the preparation. Its caus- 
tic action is painful, yet, while the drug penetrates very deeply, 
limited to the seat of application. 

Poisoning by zinc chloride is evidenced by all the symptoms 
produced by a violent corrosive irritant poison. 

The drug formerly enjoyed quite a reputation as a remedy for 
cancer, especially epithelioma, in which case it was used in the 
form of " caustic arrows " inserted in the base of the growth so as 
to separate it from the healthy tissues. 

It is used as a paste and lotion for morbid growths, lupus 
exedens, putrid ulcers, ncevi, and syphilitic sores. 

Solutions of zinc chloride are injected into polypi and scrofu- 
lous glands, and for the destruction of the pulp of decayed teeth. 



CAUSTICS OR ESCHAROTICS. 799 

A weak solution of zinc chloride is an efficient injection in 
gonorrhea, leucorrhea, and hemorrhagic endometritis. 

For caustic purposes the zinc chloride itself may be used, or 
a paste prepared with starch, gypsum, flour, anhydrous sulphate 
of lime, or powdered althea. Mayet's paste consists of zinc chlo- 
ride 8 parts, zinc oxide 1 part, dried wheat flour 7 parts, and water 
I part. The cuticle must always be removed before applying 
the paste, strong water of ammonia answering for this purpose. 

Bromum— Bromi— Bromine. XT. S. JP. 

Origin. — It is found both in sea-water and in saline springs, but 
is chiefly obtained from the mother-liquors of salt-works in the 
United States and at Strassfurth, Germany. 

Description and Properties. — A heavy, dark brownish-red, 
mobile liquid, evolving, even at ordinary temperatures, a yellowish- 
red vapor, highly irritating to the eyes and lungs, and having a 
peculiar suffocating odor, resembling that of chlorine. Soluble in 
30 parts of water and readily soluble in alcohol or ether. Bromine 
should be kept in glass-stoppered bottles, in a cool place. 

Used externally. 

Physiological Action and Therapeutics. — Bromine is a power- 
ful corrosive irritant, the fumes of which occasion severe irritation 
of the eyes and respiratory passages, with cough, hoarseness, and 
dyspnea. When taken into the stomach it produces all the symp- 
toms of corrosive poisoning. 

The drug is an active caustic, deodorant, and disinfectant. It 
was formerly extensively employed, particularly during the Civil 
War of the United States, for the treatment of hospital gangrene, 
for which it is a most efficient remedy. Bromine has also been used 
as an injection (1 part to 3 of alcohol) in various forms of cancer. 
Owing to the pain attending the operation, however, the treatment 
has not been generally adopted. 

Bromine is an efficient disinfectant, and has been employed to 
disinfect and deodorize the atmosphere of hospitals, etc. Berlin 
sanitary officials declare that " 3^ ounces of bromine can disinfect 
a space of 918 cubic feet, and deodorize a space of 7000 cubic feet." 



8oo 



A TEXT-BOOK OF MATERIA MEDICA. 



GROUP XXL— EMOLLIENTS, DEMULCENTS, 
PROTECTIVE AGENTS. 



AND 



Fats and Oils, . 



Emollients are substances which soften, relax, and protect the 
tissues to which they are applied They relieve pain and tension 
by diminishing heat and lessening the pressure on the nerves. 

Emollients and demulcents are largely interchangeable terms. 
The former are applied to the skin; the latter, to mucous mem- 
branes. 

The principal emollients are — 
Glycerin, 
Soap Liniment, 
Starch, 

Lard, 
Olive Oil, 
Almond Oil, 
Spermaceti, 
Linseed Oil, 
Cacao Butter, 
Petroleum, 
Paraffin, 
Petrolatum, 
^ Vaseline, etc. 
Hot Fomentations, 

Linseed Meal, 
Oatmeal, 
Bran, 
Bread, 
Flour, 
v Figs, etc. 

Demulcents are substances which soothe and protect the parts 
to which they are applied. They are generally of a mucilaginous 
nature, and are employed for their action upon mucous membranes, 
while emollients are principally used on the skin. The important 
demulcents are — 

Acacia, Marshmallow, Sassafras-pith, 

Barley, Liquorice, Isinglass, 

Cetraria, Starch, Honey, 

Almond, Tragacanth, Gelatin, 

Flaxseed, Glycerin, Bland Oils. 

Slippery Elm, White of Egg, 



Poultices, 



1 



EMOLLIENTS, DEMULCENTS, ETC. 801 

Both Emollients and Demulcents are exceedingly useful agents 
to relieve irritation of the skin in certain cutaneous diseases ; by 
softening the skin and mucous membranes they also prevent crack- 
ing or chapping from exposure to cold. They are also efficient 
agents to prevent bed-sores and to lessen friction between approx- 
imating surfaces, as between the nates and about the groins of 
children. 

Demulcents are employed internally with good results when 
there is an irritated or inflamed condition of mucous membranes, 
whether of the respiratory, gastro- intestinal or genito-urinary tracts, 
as in bronchitis, gastritis, enteritis, diarrhea, dysentery, strangury, 
cystitis, etc. 

Demulcents — such as flaxseed, slippery elm, marshmallow, 
or sassafras-pith — are very agreeable and efficient agents to quench 
thirst and to relieve the irritation of mucous surfaces in febrile 
affections. 

Protectives are agents used to mechanically cover and protect 
injured or diseased surfaces from extraneous influences, as from 
air, water, etc. 

Certain agents classed as protectives are employed for their 
absorptive power of taking up by capillary attraction any moisture 
or fluid present. 

They are useful agents as protective coatings to bed-sores or to 
excoriated, abraded, or burned surfaces. 
The principal protectives are — 
Collodion, 

Solution of Gutta-percha, 
Solution of Sodium Silicate, 
Court-plaster (Emplastrum Ichthyocollae), 
Lycopodium, 
Charcoal, 
Animal Charcoal, 
Purified Cotton. 
The Emollients, Demulcents, and Protectives which are deemed 
sufficiently important to merit more consideration than has been 
given them elsewhere in the present work, will be now considered. 

Glycerlnum— GlycerTni— Glycerin. IT. S. P. 
Origin. — A liquid obtained by the decomposition of vegetable 
or animal fats or fixed oils, and containing not less than 95 per 
cent, of absolute glycerin. 

51 



8o2 A TEXT-BOOK OF MA TERIA MEDICA. 

Description and Properties. — A clear, colorless liquid, of a 
thick, syrupy consistence, oily to the touch, odorless, very sweet 
and slightly warm to the taste. When exposed to the air, it 
slowly abstracts moisture. Specific gravity not less than 1.250. 
Soluble in all proportions in water or alcohol ; also soluble in a 
mixture of 3 parts of alcohol and 1 part of ether, but insoluble 
in ether, chloroform, carbon disulphide, benzin, benzol, and fixed 
or volatile oils. 

Dose. — 5-60 minims (0.3-4.0 Cc). 

Official Preparations. 

Glyceritum Amyli — Glyceriti Amyli — Glycerite of Starch. — Starch, 10; Water, 
10; Glycerin, 80. Used internally or externally. 

Glyceritum VitSlli— Glyceriti VitSlli— Glycerite of Yolk of Egg (Glyco- 
NIN). — Fresh Yolk of Egg, 45 ; Glycerin, 55. Used freely internally or externally. 

Suppositoria Glycerini — Suppositoria (ace.) Glycerini — Suppositories of 
Glycerin. — (Each suppository contains 93 grains (6.0 Gm.) of glycerin.) Used as re- 
quired. 

Glycerin is also contained in the following official preparations : 

Glyceritum Acidi Carbolici, Glyceritum Acidi Tannici, Glyceritum Boro- 
glycerini, Glyceritum Hydrastis, Mucilago Tragacanthae, M&ssa Hydrargyri 
Pllulae Ph6sphori, and in many extracts and fluid extracts. 

Antagonists and Incompatibles. — Glycerin is incompatible 
with potassium permanganate and with chromic acid. 

Synergists. — Its emollient properties may be enhanced by 
emollients and demulcents. 

Physiological Action. — Externally and Locally. — When gly- 
cerin is applied to the skin or mucous membrane it is ordinarily 
bland and unirritating, although in certain cases the drug occasions 
a sensation of burning and smarting, which may be due either to 
an impure preparation, the rapid absorption of water from the 
tissues, or merely to a marked idiosyncrasy on the part of the 
patient. Should the pure drug show a tendency to irritate the 
skin, the glycerin should be properly diluted with water. 

Preparations more concentrated than the specific gravity recom- 
mended by the U. S. Pharmacopoeia — viz. 1.25 — should be avoided, 
because of their irritating properties. 

Glycerin abstracts water from the tissues, and is rapidly absorbed 
through the skin. It possesses marked diffusive power, being 
capable of diffusing itself freely over and through organic matter. 

Internally. — The principal action of glycerin when taken inter- 



EMOLLIENTS, DEMULCENTS, ETC. 803 

nally is that of a purgative. The drug purges when given by the 
rectum, either as enema or in the form of a suppository. 

Glycerin is readily absorbed from the alimentary canal, and it 
is thought by some physicians to undergo oxidation, thereby act- 
ing as a food and increasing body-weight. Other competent inves- 
tigators allege that it is not in the least degree nutritious. 

When immoderate amounts of the drug are taken, it may be 
detected in the urine, while under excessive doses effects may be 
produced similar to those resulting from alcoholic poisoning. 

Following the ingestion of very large doses, there may be 
extreme muscular weakness, dryness of mucous membranes, dark- 
colored urine, collapse, and death. The drug is not considered 
poisonous, excessive amounts being necessary to produce the 
symptoms above described. 

Therapeutics. — Externally and Locally, — Glycerin is a popular 
and efficient remedy for chapped hands and slight excoriations. 

Fissured nipples and fissure of the anus are well treated with 
pure glycerin or with glycerin and tannic acid. The drug also 
makes an efficient application to bed-sores. 

Glycerin is employed as an injection in gonorrhea. It may be 
used alone or medicated with bismuth subnitrate or with extract 
of opium. 

Glycerin is one of the best solvents for hardened cerumen, and 
tampons wet with glycerin or with glycerite of tannic acid are 
very serviceable in leucorrhea and erosion of the cervix, and endo- 
metritis with congestion and subinvolution of the uterus. 

Glycerin possesses marked antipruritic properties, and, whether 
applied pure or combined with oils or ointments, will allay itching 
of most affections of the skin. 

Lotions or diluted aqueous solutions of glycerin are fre- 
quently employed in various diseases of the ear, nose, and throat, 
such as fissure of the tongue, chronic laryngitis, chronic nasal catarrh, 
coryza, pharyngitis, etc. 

A mixture of glycerin and water will lessen or prevent dry- 
ness of the mouth from fever or other causes. 

Glycerin is an efficient topical remedy for the reduction of 
edema of the prepuce, and is a serviceable antiseptic dressing for 
wounds, carbuncles, boils, etc. 

Glycerite of starch is an excellent soothing emollient in 
acute eczema, and quite an efficient preparation to prevent pitting in 
variola. 



804 A TEXT-BOOK OF MATERIA MEDICA. 

Glyconin (glycerite of yolk of egg) makes an agreeable, sooth- 
ing application in erysipelas, fissured nipples, etc. 

Internally. — The principal internal use for glycerin is for the 
relief of habitual constipation, being far more efficient in habitual 
than in occasional constipation, and more generally applicable to 
females than to males, and to those cases where the fecal mass is 
retained in the rectum than in the sigmoid flexure or above it. 
For the purpose of relieving constipation it may be given by the 
mouth, alone or associated with castor oil, or i or 2 fluidrachms 
(4.0-8.0 Cc.) injected into the rectum, or, which perhaps is the 
most agreeable method, by the insertion into the rectum of a 

GLYCERIN SUPPOSITORY. 

Glycerin is said to relieve the acidity, pyrosis, and flatulence of 
dyspepsia. 

It has been employed in diabetes, but without favorable results. 

Administration. — Whether glycerin be used externally or in- 
ternally, it should always be chemically pure, otherwise much irri- 
tation may be produced. 

For external use it may be used pure or mixed with water, or 
in various lotions, ointments, etc. 

Internally it is seldom given alone, but with syrups, water, 
wine, or other alcoholic liquors. 

Oleum Ollvae— Olei Ollvae— Olive Oil. Jf.S.JP. 

Origin. — The fixed oil expressed from the fruit of Olea Europcea 
L., a shrubby, thorny, medium-sized tree, indigenous in Western 
Asia, but cultivated in the countries bordering on the Mediter- 
ranean and in the Southern United States, California, and several 
South American and other countries. 

Description and Properties. — A pale yellow or light greenish- 
yellow, oily liquid, having a slight, peculiar odor, and a nutty, 
oleaginous taste, with a faintly acrid after-taste. Very sparingly 
soluble in alcohol, but readily soluble in ether, chloroform, or car- 
bon disulphide. Olive oil should be kept in well-stoppered bottles 
in a cool place. 

Dose. — Freely. 

Physiological Action and Therapeutics. — Olive oil is a singu- 
larly bland and agreeable oil, and very useful as an emollient and 
demulcent. It serves as an efficient protective to the skin, from 
which it is readily absorbed. As a lenitive and protective in cases 



EMOLLIENTS, DEMULCENTS, ETC. 805 

of superficial wounds, bruises, excoriations, burns, bites and stings of 
insects, sprains, etc. it serves a valuable purpose. 

It is extensively employed by dermatologists to soften and facili- 
tate the removal of crusts, scales, and epithelial debris of various 
cutaneous disorders. 

The application of warm olive oil, made with gentle friction to 
painful and engorged mammary glands during pregnancy and after 
parturition, generally lessens the pain and swelling. 

The drug is an efficient palliative in painful deglutition, and is 
sometimes injected into the rectum as a soothing emollient in dys- 
entery, and to destroy " seat-worms " and allay the irritation pro- 
duced by them. 

Frequently the forcible injection into the urethra of olive oil 
will dilate an unusually tight stricture, partly overcoming the dif- 
ficulty to the introduction of a sound. 

Olive oil is habitually employed as a lubricant for sounds, cathe- 
ters, specula, pessaries, etc. 

Where a fat or an oil is not contraindicated, olive oil is one of 
the most efficient demulcents to administer in cases of poisoning 
from corrosive irritating drugs. 

Olive oil is a useful and pleasant laxative, and is used to a con- 
siderable extent for that purpose. The oil is also credited with 
facilitating the discharge of gall-stones. It unquestionably increases 
the secretion of bile, which may account for its apparent influence 
in favoring the expulsion of these concretions. 

Oleum Amygdalae Expressum— Olei Amygdalae Ex- 
pressi— Expressed Oil of Almond. U.S.jP. 

Origin. — A fixed oil expressed from Bitter or Sweet Almond 
(Prunus Amygdalus, var. amara and dulcis, De Candolle), a tree 15 
to 20 feet (5 to 6 M.) high, indigenous in Western Asia and culti- 
vated in subtropical countries. 

Description and Properties. — A clear, pale straw-colored or 
colorless, oily liquid, almost inodorous, and having a mild, nutty 
taste. Only slightly soluble in alcohol ; soluble in ether, and in 
chloroform in all proportions. It should be kept in well-stoppered 
bottles, in a cool place. 

Dose. — 1-4 fluidrachms (4.0-8.0 Cc). 

Expressed Oil of Almond is contained in Unguentum Aquae 
Rosae. 

Physiological Action and Therapeutics. — The expressed oil 



806 A TEXT-BOOK OF MATERIA MEDICA. 

of almond is a peculiarly bland and agreeably efficient demulcent 
and emollient, being used both externally and internally for the 
same purposes as olive oil. 

Oleum LIni— Olei Lini— Linseed Oil. U.S. IP. 

(Oil of Flaxseed.) 

Origin. — A fixed oil expressed without heat from the seed of 
Linum Usitatissimum L. 

Description and Properties. — A yellowish or yellow, oily liquid, 
having a slight, peculiar odor, and a bland taste. When exposed 
to the air it gradually thickens and acquires a strong odor and 
taste ; and if spread in a thin layer on a glass plate, and allowed to 
stand in a warm place, it is gradually converted into a hard, trans- 
parent, resin-like mass. Soluble in about 10 parts of absolute alco- 
hol, and, in all proportions, in ether, chloroform, benzin, carbon 
disulphide, or oil of turpentine. Linseed oil should be kept in 
well-stoppered bottles. 

Dose. — \-2 fluidounces (15.0-60.0 Cc). 

Physiological Action and Therapeutics. — The action and uses 
of flaxseed oil are similar to those of olive oil. One of its most 
important uses, when mixed with an equal quantity of lime water, 
is in the treatment of burns. 

The linseed itself is used extensively as a domestic demulcent 
in the form of a tea, for cough, etc., while the ground linseed makes 
an excellent poultice for all deep-seated inflammations. 

Acacia— Acaciae— Acacia. IT. S. J?. 

(Gum Arabic.) 

Origin. — A gummy exudation from Acacia Senegal Willdenow, 
a small tree about 20 feet (6 M.) high, found in India and Africa, 
especially in the district of Khartoum, westward to Senegambia. 

Description and Properties.— In roundish tears of various 
sizes, or broken into angular fragments, with a glass-like, some- 
times iridescent fracture, opaque from numerous fissures, but trans- 
parent and nearly colorless in thin pieces ; nearly inodorous, taste 
insipid, mucilaginous ; insoluble in alcohol, but soluble in water, 
forming a thick mucilaginous liquid. Acacia should be slowly but 
completely soluble in 2 parts of water. 

Official Preparations. 
Mucilago AcSciae— Mucilaginis Acaciae— Mucilage of Acacia (34 per cent.). 
— Dose, freely. 



EMOLLIENTS, DEMULCENTS, ETC. 807 

Syrupus Acaxiae — Syrupi Acaxiae— Syrup of Acacia.— Dose, freely. 
Acacia is contained in Emulsum Amygdalae, Pulvis Cretae Compositus, and 
in some trochisci. 

Physiological Action and Therapeutics. — Acacia is a valuable 
demulcent, and gum water is in ordinary use to serve as a protective 
to inflamed and irritated mucous membranes of the respiratory, 
alimentary, and genito-urinary tracts, as in cases of pharyngitis, 
laryngitis, dysentery, gastritis, typhoid fever, and in febrile affections 
generally. The mucilage of acacia is sometimes used as a pro- 
tective for superficial burns, excoriations, etc. 



Cetraria— Cetrariae— Cetraria. U. S. I*. 

(Iceland Moss.) 

Origin. — Cetraria Islandica L., fronds of a lichen indigenous in 
the Northern Hemisphere. 

Description and Properties. — From 2 to 4 inches (5 to 10 Cm.) 
long, foliaceous, irregularly branched into fringed and channelled 
lobes, brownish above, whitish beneath, and marked with small, 
depressed spots ; brittle and inodorous ; when softened in water, 
cartilaginous, and having a slight odor ; its taste is mucilaginous 
and bitter. 

Official Preparation. 

DecSctum Cetrariae — DecScti Cetrariae — Decoction of Cetraria. 

Physiological Action and Therapeutics. — Cetraria is a demul- 
cent and tonic, and may be used for the same purposes as acacia. 
It is, however, more nutritious than acacia, and is used to a con- 
siderable extent for chronic pulmonary affections. 

Olmus-UImi-EIm. V. S. P. 

(Slippery Elm.) 

Origin. — The inner bark of Ulmus fulva Michaux, a medium- 
sized tree, from 30 to 60 feet (9 to 18 M.) high, found in the 
United States and Canada. 

Description and Properties. — In flat pieces, varying in length 
and width, about -J- inch (3 Mm.) thick, tough, pale brownish-white, 
the inner surface finely ridged ; fracture fibrous and mealy ; the 
transverse section delicately checkered ; odor slight, peculiar ; taste 
mucilaginous, insipid. 



8o8 A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparation. 
Mucilago Ulmi — Mucilaginis Ulmi — Mucilage of Elm. — Dose, freely. 

Physiological Action and Therapeutics. — Elm is a decided 
demulcent and possesses nutritive properties. It is pleasant to the 
taste and does not readily disturb the stomach. It is principally 
used as a demulcent in diseases of the gastro-intestinal and genito- 
urinary tracts, as diarrhea, dysentery, cystitis, urethritis y etc. The 
fibrous bark is moulded into tents used to dilate the neck of the 
uterus, fistulous openings, etc. 

Althaea— Althseae— Althaea. U. S. IP. 

(Marshmallow.) 

Origin. — The root of Althcea officmalis L., a perennial herb in- 
digenous in the temperate portion of Northern and Western Asia 
and in the greater part of Europe. 

Description and Properties. — In cylindrical or somewhat con- 
ical pieces, from 4 to 6 inches (10 to 15 Cm.) long, about J inch 
(12.7 Mm.) thick, deeply wrinkled, deprived of the brown corky 
layer and small roots ; externally white, marked with a number 
of circular spots, and of a somewhat hairy appearance from the 
loosened bast-fibres ; internally whitish and fleshy. It breaks with 
a short, granular, and mealy fracture, and has a faint, aromatic odor 
and a sweetish, mucilaginous taste. It contains asparagin, muci- 
lage, sugar, and pectin. 

Official Preparation. 
Syrupus Althseae — Syrupi Althseae. — Syrup of Althaea. — Dose, freely. 

Physiological Action and Therapeutics. — Marshmallow is 
emollient, demulcent, and protective, and is an efficient protective 
and emollient in irritable and inflamed conditions of the skin, and 
a highly efficacious demulcent in all inflammatory and irritable 
conditions of the respiratory, digestive, and urinary organs. 

Tragacantha— Tragracanthae— Tragracanth. U. S. P. 

Origin. — A gummy exudation from Astragalus gummifer Labil- 
lardiere, and from other species of Astragalus, low shrubs, indige- 
nous in a portion of the territory lying between Eastern Persia and 
Greece. 

Description and Properties. — In narrow or broad bands, more 
or less curved or contorted, marked by parallel lines or ridges, 
white or faintly yellowish, translucent, horn-like, and tough. It 



EMOLLIENTS, DEMULCENTS, ETC. 809 

contains 33 per cent, of a gum, bassorin, which is only slightly 
soluble in water. 

Official Preparation. 

Mucilago Tragac&nthae — Mucilaginis Tragacanthae— Mucilage of Traga- 
canth. — Dose, freely. 

Physiological Action and Therapeutics. — Tragacanth is de- 
mulcent and nutritious, and may be used for the same purposes 
as acacia, Iceland moss, etc. The mucilage of tragacanth is sin- 
gularly efficacious as a soothing emollient in chapped hands and 
irritable conditions of the skin. 

Sassafras Medulla— Sassafras Medullae— Sassafras 

Pith. U.S.JP. 

Origin. — The pith of Sassafras variifolium (Salisbury) O. 
Kuntze, a tree indigenous in North America. 

Description and Properties. — In slender, cylindrical pieces, 
often curved or coiled, light, spongy, white, inodorous, and insipid. 
Macerated in water, it forms a mucilaginous liquid, which is not 
precipitated by the addition of alcohol. 

Official Preparation. 

Mucilago Sassafras Medullae — Mucilaginis Sassafras Medullae — Mucilage 
of Sassafras Pith. — Dose, freely. 

Physiological Action and Therapeutics. — Mucilage of Sassa- 
fras Pith is an agreeable demulcent and a mild local stimulant, and 
may be used for the same purposes as slippery elm, tragacanth, 
acacia, etc. It forms a pleasant vehicle for more active remedies. 

Ichthyocolla— Ichthyocollae— Isinglass. TJ. S. JP. 

Origin. — The swimming-bladder of Acipenser Huso L. and of 
other species of Acipenser. 

Description and Properties. — In separate sheets, sometimes 
rolled, of a horny or pearly appearance; whitish or yellowish, 
semi-transparent, iridescent, inodorous, insipid; almost entirely 
soluble in boiling water and in boiling alcohol. A solution of 
isinglass in 24 parts of boiling water forms, on cooling, a trans- 
parent jelly. 

Dose. — Freely. 



810 A TEXT-BOOK OF MA TERIA MEDICA. 

Official Preparation. 

Empl&strum IchthyocSllse — Empl&stri Ichthyoc811ae — Isinglass Plaster — 

(Court Plaster). 

Physiological Action and Therapeutics. — Isinglass is emol- 
lient, demulcent, and protective, and possesses nutritive properties. 
Isinglass plaster is commonly employed to protect abraded sur- 
faces and slight cuts of the skin. It should be moistened with 
pure water and never with saliva. 

Lycopodium— Lycopodii— Lycopodium. U. S.P. 

Origin. — The spores of Lycopodium clavatum L. and of other 
species of Lycopodium, low-creeping perennials found in dry 
woods distributed over the greater portion of the globe. 

Description and Properties. — A fine powder, pale yellowish, 
very mobile, inodorous, tasteless, floating upon water and not 
wetted by it, but sinking on being boiled with it, and burning 
quickly when thrown into a flame. Under the microscope the 
spores are seen to be sphaero-tetrahedral, the surfaces marked with 
reticulated ridges, and the edges beset with short projections. 
Lycopodium contains a fixed oil and a minute quantity of a volatile 
base, methylamine. Used principally externally. 

Physiological Action and Therapeutics. — Lycopodium is an 
admirable protective, and possesses great power of absorbing oils. 
Its lightness, dryness, and absorptive power render it an excellent 
dusting powder for excoriated surfaces, eczema, herpes, intertrigo 
erysipelas, superficial ulcers, etc. 

Its peculiar property of not being wetted with water makes it 
a valuable protective to prevent irritation or chafing caused by the 
urine or alvine dejections of infants. 

The drug is used as a basis for insufflations and in pharmacy 
to prevent the adhesion of pills. 



PRESCRIPTIONS. 8 1 1 



PRESCRIPTIONS. 



A prescription (L. prce, for ; scribo, I write) is an order on the 
pharmacist to compound for the patient certain medicines intended 
to meet the requirements of the individual case. Considering it as 
an order, therefore, it should begin with the Name of the person for 
whom it is designed and the Date on which it is written. In some 
cases it may be advisable to omit the name, but the date should 
never be omitted. 

The date is often indicated by the calendar number, instead of 
the name of the month, thus : 3. | March, 3d month | 10. | day of 
the month | '99. | year | . Unfortunately, there is no uniform 
usage in this respect, some persons writing the number and others 
the day of the month first, so that a druggist unfamiliar with the 
custom of the physician could not know whether 3. 10. '99. meant 
March 10th or October 3d of the year. The Latin numerals are 
also employed to designate the month : III. 10. '99. To avoid all 
chance of error, it is best to abbreviate the month or write it in 
full: March 10, 1899. The importance of the date is manifest 
from its value to the physician or pharmacist as a reference, and 
the possibility of its evidence being required in medico-legal 
contingencies. 

After the name and date comes the prescription proper, the 
name of the article required or the ingredients in case of a mixture. 
In the latter instance the various ingredients are written in a cer- 
tain order or sequence with reference to their medicinal action or 
importance, which usually is also in accord with their pharma- 
ceutical requirements for satisfactory dispensing. 

For the purpose of examination a regular prescription may be 
divided into six parts : 

1. The name of the patient and the date of the order ; 

2. The superscription, or heading, indicated by the symbol ^, 
standing for the Latin word Recipe, " take ; " 

3. The inscription, expressing the names and quantities of the 
ingredients ; 

4. The subscription, being instructions to the pharmacist or 
compounder; 

5. The signature, containing directions to the patient or attendant ; 

6. The Name of the Physician. 



812 A TEXT-BOOK OF MATERIA MEDIC A. 



ks 


:ample : 
For Mrs. B . 


July 3, 1899. 




i^. 1 Olei morrhuae, 


f Sij ; ) 




Vini albi, 


fS;> 2 




Glyceriti vitelli, q. s. ad 


fSviij. J 




Fiat emulsio. 3 






Sig. Tablespoonful after meals. 


4 

Dr. P 


H 


sre the small numeral or exponent, 1 , is 


the superscription ; 2 , 



the inscription ; 3 , the subscription ; 4 , the signature. 

A typical prescription consists of a formula of four divisions : 

The Basis, or principal active agent ; 

The Adjuvant, or auxiliary, to aid the action of the Basis ; 

The Corrective, to correct or modify its action ; 

The Vehicle, to give proper form or taste to the whole. 

Each ingredient should have a separate line, although it is not 
necessary that all prescriptions should include the above complete 
formula. 

Combination of Drugs. 

In writing a prescription we assume that it is intended, as should 
always be the case, to fulfil a single therapeutic purpose only ; and 
we are to decide first, whether the medicine shall be administered 
in a solid or in a liquid form ; and second, whether a single medi- 
cine shall be prescribed or a combination of remedies. 

The drug upon which we base our expectations of success, the 
Basis of the inscription, should always be written first, and this 
drug may be the only one required. Frequently, however, some 
other drug is necessary to assist the action of the Basis, which 
substance would be the Adjuvant (Lat. adjuvare, to assist). No 
general rule can be laid down in this matter. The course to pursue 
will depend entirely upon the therapeutic indication, the physio- 
logical action of the drug, and the idiosyncrasies of the patient. 
The tendency to-day, among many able therapeutists and clinicians, 
is to prescribe single drugs or simple combinations, while the pre- 
scriptions of former times are good examples of polypharmacy. 
There is, at all events, danger in going to the extreme of sacrificing 
therapeutic efficiency to simplicity of form and elegant pharmacy ; 

1 In ancient times it was customary to preface a prescription with a pious invocation 
to Jupiter or some guardian deity. These prayers were finally abbreviated, until they 
came to be expressed by the simple astronomical sign 9.J., symbol of the planet Jupiter. 
The upright stroke across the letter R heading modern prescriptions is a curious relic of 
the above heathen usage condensed in the planetary sign. 



PRESCRIPTIONS. 813 

and it must be confessed that such compounds as Warburg's tinc- 
ture and the bolus prescribed by Dr. Graves in the treatment of 
dropsical patients prove the efficacy of polypharmacy in many 
cases. 

Curare Base To cure 

Cito Adjuvant Quickly 

Tuto Corrective Safely 

Et jucunde Vehicle ^ 

^ > And pleasantly. 

Diluent J 

The hackneyed rule of Asclepiades that medicines should 
always be so combined as to cure quickly, safely, and pleasantly 
(curare, cito, tuto, et jucunde) has resulted in the adoption of the 
above form of inscription. 

The theoretical prescriber writes by rule, religiously avoids 
incompatibles, and would be shocked by, and have little respect 
for, a physician who should deliberately include in the same pre- 
scription the names of substances directly antagonistic to each 
other physiologically. The subject will be further discussed here- 
after. 

As a general rule, we prescribe only one drug to provoke 
emesis, and a combination of several if we wish a diuretic. A 
purgative is usually multiple, but if the selection be castor oil or 
croton oil, it will be single. 

After we have selected the Basis, or chief ingredient, of our 
prescription, the next point to determine is whether we can add 
anything which will in any manner be of real assistance to that 
Basis. This ingredient, or Adjuvant, as it is called — has usually a 
physiological action similar to that produced by combining two 
cathartics or two diuretics acting upon different portions of the 
intestines or kidneys. Sometimes, however, an Adjuvant may 
differ in its effects — as sulphuric acid serves as an Adjuvant to 
quinine, by favoring its absorption and thereby hastening and 
increasing its action, as mercury assists the action of squills upon 
the kidneys, or iron acts as an Adjuvant to a cardiac stimulant. 

The Adjuvant, as a rule, should not be directly opposed in its 
action to that of the Basis, as chloral is to strychnine, a diuretic to 
a diaphoretic, or a typical cardiac stimulant to a cardiac depressant. 

Having chosen the Adjuvant, the next point to consider is 
whether the action of the drugs selected may not be rendered 
more kindly through the addition of some other substance as a 



814 A TEXT-BOOK OF MATERIA MEDICA. 

corrective. A substance may be added which will correct some 
disagreeable effect of the active agents by producing a medicinal 
impression upon the patient. Extract of belladonna or hyoscya- 
mus relieves the griping occasioned by some of the more violent 
cathartics, like podophyllin, and other well-known instances of this 
kind are those of the aromatic spirit of ammonia, which mitigates 
the unpleasant symptoms of iodism, and hydrobromic acid, which 
lessens the untoward action of quinine. 

Again, a corrective may act by producing some chemical effect 
upon the Basis — as salicylic acid is rendered more soluble and less 
irritating by combining it with sodium carbonate or bicarbonate, 
forming the sodium salicylate. 

Great care and thought should be given not only to the Basis, 
Adjuvant, and Corrective, but also to the Vehicle, which claims 
equal attention. A prescription is often rendered more kindly, and 
no less efficient, through the medium of some substance producing 
a more agreeable taste. It is a mistaken idea that medicines, in 
order to be effective, should be repulsive to the patient. The 
homeopath's success is largely due to the very agreeable taste of 
his remedies. The mere caprice of the patient, however, should 
not be considered in the choice of a remedy when, in the best 
judgment of the physician, it is indicated. Still, it is well to study 
carefully the art of prescribing agreeable doses, so far as may be 
compatible with fidelity to science. It is to be noted that pleasant- 
ness of taste is far more important in the case of fluids than in that 
of solids. 

Aromatic elixirs, syrups, aromatic waters, etc. are in frequent 
use as Vehicles, yet it must be remembered that oftentimes a sen- 
sitive patient repudiates sweets and syrupy mixtures. In many 
cases simple syrup or pure water serves, after all, as the best vehi- 
cle, although the physician's choice must be governed mainly by 
experience. 

It will be observed that in the body of the present work, in the 
majority of cases, the method of administration is fully explained. 
It may here be noted that liquids are much more readily absorbed 
than solids, yet adults usually prefer to take medicines in the solid 
form, such as pills, capsules, powders, and tablets. In illness the 
patient's condition is often such that the gastric and intestinal secre- 
tions are greatly reduced, and there may not be sufficient fluid to 
dissolve the solid, so as to render it in a condition to be absorbed. 
It frequently happens, for instance, that pills are voided with the 



PRESCRIPTIONS. 815 

stools unchanged, and, on the other hand, solid substances, such as 
pills or capsules, may remain in the intestinal canal until the secre- 
tions are restored, when the accumulated medicine will all be acted 
on at once, and, passing into solution, be absorbed in excessive 
doses. Such is the frequent cause of the cumulative effect which 
sometimes occurs, not without serious consequences. 

Even alkaloidal salts, which are readily soluble, are, perhaps, in 
many instances, best given in solution. 

Infants require liquid medicines, water or syrup being the best 
vehicle. Bitter medicines, like quinine, may be given in aromatic 
elixir of liquorice or syrup of yerba santa. As a general rule the 
metals and their compounds should be administered in the form of 
pills or in a small quantity of fluid. The purgative salts, potas- 
sium iodide, and the diuretics, are best given in large quantities of 
fluid. 

Prof. H. C. Wood, M. D., has written so clearly upon the art of 
combining, or, more correctly speaking, associating, medicines that 
we cannot do better than quote his observations verbatim: 

" The art of combining medicines is not a difficult one, but in 
practice certain principles should not be lost sight of. Chief of 
these are, to prescribe as few remedies as possible, and to use no 
powerful drug without a very distinct idea of what it is intended to 
do. Whenever it is desired to give a powerful remedy in increasing 
doses until its physiological effect is produced, it should always be 
given by itself. Thus, it may be necessary to give arsenic so as to 
impress the system, at the same time that iron is indicated ; but the 
two remedies should be given separately, so that the dose of either 
can be increased or diminished independently of the other." 

The principles of combination formulated below were long ago 
enunciated by Dr. Paris, but are to-day as imperative as ever. 
Medicines are combined — 

" First. To augment, correct, or modify the action of a medicine. 
Thus, purgatives act much more kindly when a number of them 
are united together. The chief reason of this probably is that, as 
different remedies affect different portions of the gut, the whole in- 
testine is best reached by a union of the diverse substances. It 
may take an intense irritation of the mucous membrane to purge 
as actively as does a mild irritation of both the mucous membrane 
and the muscular coat. 

" There are powerful medicines which act similarly upon some 
parts of the organism, but dissimilarly upon other parts. By com- 



816 A TEXT-BOOK OF MATERIA MEDICA. 

bining such remedies powerful effects can be obtained at the points 
where the two lines of action cross each other, without influencing 
to a great extent other portions of the system. .Thus, chloral pro- 
duces sleep by its action upon the brain, and also has a distinct 
influence upon the heart, but none upon the intestinal tract. Mor- 
phine acts upon the brain, and does not influence the heart, but has 
a powerful effect upon the intestinal tract. By combining chloral 
and morphine we get an overwhelming conjoined influence upon 
the brain in producing sleep, with the least possible disturbance of 
the heart and of the intestinal tract. 

" Second. To obtain the joint action of two or more diverse 
remedies. Thus, in a cough-mixture morphine may be included to 
quiet the cough, whilst ipecacuanha and squill (in accordance with 
the first principle) are added to affect the mucous membrane. The 
application of this principle requires caution, or the practitioner 
will be led into that chief abomination — polypharmacy. It is worse 
than futile to attempt to prescribe for every symptom. It is the 
underlying cause of the disorder, or the under-stratum of bodily 
condition, which must be sought out and prescribed for simply. 

" Third. To obtain a special combination which is really a new 
remedy, or which experience has shown acts almost as a new 
remedy. Thus, when to potassium iodide in solution corrosive 
sublimate is added a new chemical compound (potassio-mercuric 
iodide) is formed, which experience has shown to be of great value 
in syphilitic diseases. Griffith's antihectic mixture (mistura ferri 
comp.) is another instance of the use of chemical changes, the 
protocarbonate of iron (ferrous carbonate) being formed out of 
the sulphate of the metal and the potassium carbonate. In the 
famous Dover's powder no chemical change occurs, but the ordi- 
nary action of opium upon the skin is so enhanced by the ipecac 
that the combination may be looked upon almost as a new remedy. 

"Fourth. To afford a suitable form. Thus, acacia is added to 
make an emulsion, or confection of rose to make a pill. In the 
choice of excipients care should be exercised to select a substance 
free from medicinal properties, having no chemical incompatibility 
with the medicinal agent and of suitable physical character. Bread- 
crumb often makes a good excipient for pills, but with silver 
nitrate it is chemically incompatible, on account of the sodium 
chloride it contains. 

" When writing a prescription the utmost care should be taken 
to use such excipients that the combination should not only be 



PRESCRIPTIONS. 817 

attractive to the eye, but also as little repulsive to the palate as 
may be. Whenever possible the pill form should be employed 
with bitter or disagreeable medicines. The pill may be readily 
coated with silver-foil ; tonic pills may be coated with iron by 
shaking or rolling them in ferri pulvis while soft and sticky. 
Sugar-coated pills and ' compressed pills ' are apt to get so hard 
and insoluble that their use requires caution. In regard to mixtures, 
flavoring oils should be freely used, and the power of glycerin to 
conceal the disagreeable taste of many substances should be 
remembered." 1 

As vehicles for liquid mixtures for internal use the following 
classes of official preparations are best adapted — The aromatic 
waters : rose, anise, fennel, and the mints when flavor alone is 
desired, the most delightful flavor of all being orange flower 
water. The aromatic syrups : orange, orange flower, and tolu 
when it is desired to disguise the taste and to suspend resinous or 
otherwise sparingly soluble substances in the mixture. The elixirs 
when in addition to agreeable flavor it is desirable to employ a 
vehicle as a solvent for certain salts not readily soluble in water or 
syrups. The elixirs containing about 25 per cent, of alcohol, they 
are useful vehicles for tinctures and fluid extracts of resinous 
drugs such as cubeb, buchu, uva ursi, valerian, viburnum, etc. 

When flavor alone is desired the elixir aromaticum, U. S. Ph., 
a delightful combination of orange and other aromatics, should 
be used. To disguise the taste of bitter drugs, as in the last men- 
tioned, elixirs of licorice, or of eriodictyon (yerba santa) are mostly 
employed. 

Incompatibility. 

Due regard is to be paid to the mutual chemical, pharmaceutical, 
and therapeutical relations of the drugs combined in a prescription. 

When different substances, whether liquid or solid, are com- 
bined or associated and undergo a more or less complete change, 
they are said to be incompatible, the incompatibility consisting of 
three kinds : chemical, pharmaceutical, and therapeutical, although 
the last division is not scientifically correct, since one substance 
cannot be therapeutically incompatible with another, although it 
may be a physiological antagonist. 

The incompatibles and antagonists of the different substances 
are fully mentioned under the respective drugs. The principles 
governing incompatibility, however, may well be considered here. 

1 Therapeutics, 7th edition, pp. 108 et seq. 
52 



818 A TEXT-BOOK OF MATERIA MEDICA. 

Chemical incompatibility is of the most importance. 
The commonest forms of chemical incompatibility occur under 
the following conditions : 

1. When a new and insoluble salt is formed, resulting from a 
mixture of solutions of soluble salts. Example (i) : mixing solutions 
of lead acetate and zinc sulphate, both soluble salts, but producing 
by chemical decomposition a new and insoluble salt, the sulphate 
of lead, which is precipitated. 

2. By the addition of a strong acid to solutions of salts of 
weak or volatile acids, such as carbonates and bicarbonates, with 
resulting decomposition. Example (2) : ammonium carbonate, the 
salt of a weak acid radical, added to syrup of squills, containing 
acetic acid, causes decomposition to take place, with effervescence 
and the liberation of carbonic acid gas. 

3. Salts of a feeble or volatile base are decomposed by the 
addition of a strong alkali. Example (3) : the evolution of ammonia 
when a strong alkali is added to ammonia alum, and when chloral 
hydrate is decomposed by alkalies, such as aromatic spirit of 
ammonia, lime solution, etc. 

4. Alkaloids, or their salts, are thrown out of solution or pre- 
cipitated from their solutions by the addition of alkalies or alkaline 
salts. Example (4) : sulphate of strychnine in solution is precipitated 
as the insoluble bromide of strychnine by the addition of a larger 
proportion of potassium bromide. Quinine sulphate is precipitated 
as insoluble quinine acetate when mixed with a solution of potas- 
sium acetate. 

5. Tannic and gallic acids and preparations containing them, 
as well as many other vegetable acids, produce discoloration or 
precipitation of iron and many of its compounds. Example (5) : ink 
is the best illustration of this incompatibility. Writing fluids are 
usually combinations of tannic or gallic acid with some preparation 
-of iron. Add the tincture of ferric chloride to tincture of cinchona, 
and notice the discoloration. 

There are certain preparations of iron, like the compounds with 
ammonium or sodium citrate (see tinct. ferri citro-chloride, N. F., 
tasteless tincture of iron) which produce little discoloration with 
vegetable astringents, and none at all with vegetable preparations 
containing no tannic or gallic acid. 

Pharmaceutical incompatibility is the production of fewer or 
more insoluble substances in mixtures or preparations of vegetable 
drugs, associated or not with any chemical compounds. Pharma- 



PRESCRIPTIONS. 



819 



ceutical incompatibility may occur in liquids or solids, although 
much more frequent in liquid mixtures, causing a separation of 
either inert or active ingredients. Examples : vegetable tinctures 
of resinous drugs with water, such as tincture of guaiac and water ; 
copaiba and oils with aqueous preparations ; spirit of nitrous ether 
with mucilage of acacia, etc. The separation or precipitation may 
frequently be prevented by the intervention of some viscid sub- 
stance, such as syrup, glucose, glycerin, mucilage of acacia, etc. 

Incompatibility may be both chemical and pharmaceutical. In 
the following list the substances which cannot be classed as incom- 
patible under any of the above divisions are given for reference : 



Substance. Incompatible with 

A . f Alcohol, alcoholic and ethereal tinctures 

Acacia -< \ 

y. chloride ; lead salts. 

Alkalies, alkaline solutions; metallic oxides. 

r 



Acids in general 

Acid. 

Arsenous. 
Salicylic , 

Tannic . , 

Bismuth. 

Subnitrate 
Chloral. 

Hydrate . 

Iodine .... 

Lead. 

Acetate . , 



Mercury. 
Bichloride 
Mild chloride 
(Calomel) 

Potassium. 

Chlorate . . 



Iodide . . . 

Permanganate 

Sodium. 

Bicarbonate . 
Bromide . . 

Silver. 

Nitrate . . . 



* borax ; ferric 



-j Ferric hydrate ; magnesia ; lime water. 

\ Iron compounds ; potassium iodide ; * lime water. 

j Alkalies, carbonates and bicarbonates ; lime water; chlorine 

I water; albumin; gelatin. 

< Calomel ; * sulphur ; tannin. 

r Alkalies, carbonates ; * ammonium and mercury compounds ; 
\ potassium bromide and alcohol. 

f Ammonia;* alkalies, carbonates; chloral; metallic salts; 
I starch.* 

{Acacia ; acid hydrochlor. ; acid sulphuric and sulphates ; 
ammon. chloride; carbonates; lime water, iodine; potas- 
sium iodide ; tannin. 



<l Potassium iodide ;* salts, carbonates ; tannin ; borax. 

r Acids, acid salts; alkalies, carbonates; ammon. chloride; 
\ iodine; potassium iodide ; ferric chloride, iodide ; sulphur. 

/ Acids, mineral; calomel; organic substances ; sulphur. 

r Acids, acid salts ; alkaloids ; iron ; lead and mercury salts ; 

\ potassium chlorate; silver nitrate; chlorine water. 

( Ammonia, salts; alcohol; glycerin; ethereal oils; organic 

/ substances. 

[ Acids, acid salts ; acid, tannic; alkaloids; metallic salts. 

J Acids, mineral ; chlorine water ; mercury compounds. 

{Acids, acetic, hydrochloric, hydrocyanic, sulphuric, tartaric, and 
their salts; alkalies, carbonates; iodine; potass, iodide, 
bromide; sulphur. 

Those marked with an * are sometimes directed to be compounded for the purpose 
of effecting some special change or producing new compounds. 



820 A TEXT-BOOK OF MATERIA MEDICA. 

Among the above, potassium permanganate forms an explosive 
mixture with glycerin ; so does chromic acid. Chlorates of potas- 
sium, etc. explode when triturated with sulphur. The strong acids, 
nitric and sulphuric acids, and especially mixtures of these, react 
so strongly with volatile oils (hydrocarbons) as to cause explosion. 
Iodine affects these oils in the same way— fulminates. 

It not infrequently happens that the physician intentionally 
writes a chemically incompatible prescription. " Black wash " and 
" yellow wash " are examples. Other instances are such pharma- 
copoeial preparations as liquor ammonii acetatis, mistura ferri com- 
posita, and liquor magnesii citratis. 

Physiological antagonists are often given together, as atropine 
and morphine, or aconite and digitalis in certain cases of cardiac 
arrhythmia. 

No general rule can be laid down for the avoidance of so-called 
therapeutical incompatibility. Some of our most valuable drugs 
contain active principles which are physiologically opposed to each 
other in their action ; instance : jaborandi, which contains two abso- 
lutely antagonistic alkaloids, pilocarpine and jaborine, the latter in 
small quantity, yet sufficient to control the action of the former. 
Digitalis contains several distinct principles, one of which, digi- 
tonin, is the direct antagonist of the others. 

Opium is a conspicuous example of a complex remedy, con- 
taining, besides gum, sugar, etc., eighteen different alkaloids, two 
neutral principles, and two peculiar acids ; so that a prescriber of 
this drug, while he may, perhaps, flatter himself that he is con- 
forming strictly to the present notions of pharmaceutical simplicity, 
is in effect a polypharmacist of most pronounced type. Moreover, 
not only are the constituents of opium very numerous, but, like 
others mentioned, the drug affords in its thebaine and morphine 
a further illustration of direct physiological antagonism. 

The author cannot too strongly recommend that physicians 
ignorant of the physiological action of drugs in large and small 
doses, if they prescribe at all, should avoid including many reme- 
dies in one prescription. Such practitioners had best adhere to a 
single remedy or adopt homeopathy. But, given a competent and 
thorough knowledge of the action of drugs and the exact condi- 
tion of the patient, the physician is justified in giving one or twenty 
drugs in the same prescription, since he is perfectly familiar with 
the several agents of relief, and can foretell with nicety the effect 
to be produced by their combination ; and in all cases a physician 



PRESCRIPTIONS. 821 

should be as certain of the action, strength, and reliability of the 
drugs he administers as the surgeon of the aseptic condition of his 
hands and instruments. 

Estimation of Amounts in a Prescription. 

Having decided upon the various ingredients which are to enter 
into the prescription, the next consideration is the amount of each 
desirable. 

In the first place, do not prescribe more than the prognosis 
seems to call for. If in your judgment the patient will not require 
medicine more than five or six days, and not oftener than three 
times a day, a two-ounce mixture should be prescribed if a liquid, 
or the required number of pills, powders, capsules, etc., if a solid 
is desired. 

In prescribing liquid medicines note must be taken of the 
several sizes of medicine-vials, their capacities being in this coun- 
try 1, 2, and 4 fluidrachms, and 1, 2, 3, 4, 6, 8, 12, and 16 fluid- 
ounces. In the larger cities vials may also be had of metric 
capacities — 30, 60, 90, 120, 240, and 500 Cc. While it is not 
essential, it is in much better taste to have a prescribed mixture 
aggregate just a bottleful of one of the above sizes. Where two 
different mixtures for the same person are prescribed, or differ- 
ent mixtures for different persons in the same house or family, 
it is well to order them put up in vials of different sizes to avoid 
confusing the medicine. This is especially desirable when both 
internal and external remedies are prescribed for the same person. 

The amounts of the ingredients requisite for any given prescrip- 
tion are determined in various ways. The amount of the active 
ingredients will of course be the product of two factors, the quan- 
tity of dose and the number of doses required ; and the quantities 
must be such as can be expressed in the system of weights and 
measures adopted, and indicated by round numbers such as best 
conform to the relation between the denominations of the particular 
system followed in the prescription. 

There is no difficulty in computing the amounts in a solid mix- 
ture, powders, pills, or suppositories, especially if ten or its multiple 
is prescribed, nor in external preparations, where the strength is 
expressed by percentage, and are therefore most convenient lv and 
accurately prescribed according to the metric system ; but main- 
additional considerations occur in estimating amounts in fluid 
mixtures. 



822 A TEXT-BOOK OF MATERIA MEDICA. 

Frequently solids like salts, etc. are prescribed in solution, but 
their bulk may be safely disregarded in the estimation of amounts 
of the liquid measure ; for a solid in the quantity usually prescribed 
increases the whole volume of the solution but very little. Ordi- 
narily a fluidrachm (4.0 Cc.), or a teaspoonful, should not contain 
over 5 grains (0.32 Gm.), nor a tablespoonful, or 4 fluidrachms (15.0 
Cc), over 20 grains (1.29 Gm.), of a solid in solution, unless the 
substance be very bland, when twice these quantities are permissible. 

The following is a very simple rule for estimating amounts in 
Apothecaries' Measure : 

In an eight-ounce mixture, the dose being a drachm, take as 
many drachms of the medicine as there are wanted minims or 
grains to the dose. It will be observed that in this case the basis 
is an eight-ounce mixture, yet it typifies the rule, which, when 
thoroughly understood, may easily be applied to a four-ounce or a 
two-ounce mixture, one-half or one-fourth as many drachms ; 
while if the dose is to be a dessertspoonful^ or two drachms, it is 
only necessary to take one-half as many drachms to an eight-ounce 
mixture, reducing for smaller mixtures in accordance with the rule. 
If the dose be a tablespoonful, or four drachms, one-fourth as many 
drachms must be taken to an eight-ounce mixture as there are 
minims or grains to the dose. This rule, while not fractionally 
exact, is sufficiently accurate for all practical purposes. 

Examples : We desire to give an eight-ounce mixture, with a 
drachm for a dose, each dose to contain 12 grains of potassium 
bromide and 10 grains of chloral, the vehicle to be syrup of orange 
and water. We have here, then, 64 doses of a drachm each : to be 
exact, therefore, we should have 768 grains of potassium bromide, 
or 1 2 drachms and 48 grains ; but, following the rule, we put in 
the mixture 12 drachms, since we desire 12 grains to the dose. 
Of chloral we would require exactly 640 grains, or 10 drachms 
and 40 grains, but we use the round number, 10 drachms, in the 
mixture. We see that in each case there is but the fraction of a 
grain short in the dose. 

The prescription would consequently be written as follows : 

3, 



Potassii bromidi, 


3xij ; 


Chloralis, 


3x; 


Syrupi aurantii, 


3iv; 


Aquae, 


q. s. ad ^viij. 



M. et ft. sol. Sig. Teaspoonful for a dose. 



PRESCRIPTIONS. 823 

This is more of each ingredient than should be prescribed in a 
fluidrachm. It were better, then, that the dose should be a dessert- 
spoonful, or two drachms ; and in order that the two teaspoonfuls 
should contain only 12 grains of potassium bromide and 10 grains 
of chloral, the whole amount of the medicament must be divided 
by 2 — i. e. the prescription should read : 

1^. Potassii bromidi, 3vj ; 

Chloralis, 3v ; 

Syrupi aurantii, 5iv ; 

Aquae, q. s. ad 3 viij . 

M. et ft. sol. Sig. A dessertspoonful for a dose. 

In case the prescription be for a four-ounce mixture, with a 
dessertspoonful for a dose, the amounts of the solid substances 
would, of course, be one-half, and if for a two-ounce mixture, one- 
fourth of the above. 

When writing a prescription put down first all the ingredients 
which are to enter into the combination, and after the last one, 
which is usually the vehicle, write the whole amount; i.e.\i it is 
to be a four-ounce mixture, write after the name of the vehicle 
" q. s. ad f^iv." Then begin with the Basis, the first ingredient, 
and write the amount required in the whole mixture. In other 
words, decide upon the doses to be given after the medicines have 
been selected. 

It is important to adopt as a golden rule to carefully and delib- 
erately read over the entire prescription before it is handed to the 
patient, and more especially to scrutinize each item and the quanti- 
ties to guard against transposition of the latter, which otherwise 
may result in a fatal error. 

The next thing to be determined is the manner in which the 
medicine should be measured out to the patient for internal use. 
A graduated medicine-glass is always preferable to a domestic 
measure, and should be ordered in all cases.. Teaspoons, as 
well as dessertspoons and tablespoons, vary considerably, besides, 
owing to adhesion, may, according to the manner in which they 
are filled, show a variation of nearly 50 per cent, in their capacity. 
A teaspoonful, considered to be equivalent to one fluidrachm, may 
contain from one-half to two fluidrachms ; a dessertspoonful, which 
should be equivalent to two fluidrachms, and a tablespoonful, equal 
to one-half fluidounce, vary almost as much in capacity. 

It is necessary to be exact in the administration of medicines, it 



824 



A TEXT-BOOK OF MATERIA MEDIC A. 



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PRESCRIPTIONS. 825 

being well known that the action of drugs varies greatly with the 
size of the dose, small doses in their action being often directly 
opposite to large doses. 

Ordinarily, it is unwise to prescribe medicines to be dropped 
out, since a drop varies greatly in dimension according to the vis- 
cosity and specific gravity of the fluid, the shape, size, and charac- 
ter of the neck and lip of the bottle, as well as its degree of fulness, 
and the steadiness of the hand in dropping. 

In computing doses of powerful medicines, therefore, always 
estimate for minims instead of drops. 

Direct the use of a " dropper " or minim pipette for the admin- 
istration of liquids by drop doses, such as Fowler's solution, 
collyria, etc. There are exactly sixty minims of any fluid to one 
fluidrachm, while sixty drops may be fewer or more than one 
drachm, as the following list shows : 

Drops in f 3j Weight of f 3j. 

(60 M.). Gr. Gm. 

Acidum Carbolicum Ill 59 3.82 

Acidum Sulphuricum Aromaticum .... 146 53 3.43 

^Ether Fortior 176 39 2.52 

Chloroformum Purificatum 250 80 5.18 

Creosotum 122 56^ 3.66 

Ext. Belladonnae Fluidum 156 57 3.69 

Ext. Colchici Radicis Fluidum 160 55 3.56 

Ext. Digitalis Fluidum 134 62 4.01 

Liq. Iodi Compositus 63 . 59 3.82 

Liq. Potassii Arsenitis 57 55 3.56 

Oleum Caryophylli 130 57 3.69 

Oleum Tiglii 104 50 3.24 

Spiritus Ammonise Aromaticus 142 48 3.11 

Syrupus Ferri Iodidi 65 77 4.98 

Syrupus Scillse Compositus 102 70 4.53 

Tinctura Aconiti 146 46 2.98 

Tinctura Belladonnae 137 53 . 3-43 

Tinctura Cantharidis 1 31 51 3-33 

Tinctura Ferri Chloridi 150 53 343 

Tinctura Nucis Vomicae 140 44 2.85 

Tinctura Opii 130 53 3.43 

Tinctura Veratri Viridis 145 46 2.9S 

Vinum Colchici Seminis in 54 3-49 



Language and Grammatical Construction of Prescriptions. 

A prescription is written partly in Latin, partly in English. The 
name of the patient and the date should be in English ; the super- 
scription in Latin abbreviations ; the inscription in Latin ; the sub- 



826 A TEXT-BOOK OF MA TERIA MEDICA. 

scription in Latin or Latin abbreviations ; and the signature, or 
directions to the patient, in English. 

A prescription properly and unmistakably written is a cardinal 
requisite to the successful administration of medicine, no less than 
to its correct preparation by the druggist. Every practitioner and 
pharmacist should possess some knowledge of Latin grammar, yet 
by the observance of a few simple rules one wholly ignorant of 
the language may acquire a proper use of the forms generally 
adopted ; and a little study, aided by constant practice, will soon 
fix in the memory the peculiarities of gender, case, and number, 
together with the agreement of adjectives, to be met with in all 
prescriptions. 

It is to be observed that the Latin tongue has been chosen 
as the medium of medical and pharmaceutical instructions because 
of its conciseness, stability, and universal acceptance by the scien- 
tific world. Moreover, the Latin name is specific, while the English 
name may refer to several drugs of entirely different properties : 
for instance, " Snake root," applied by residents of this or that 
locality to Cimicifuga racemosa, Aristolochia serpentaria, Asarum 
Canadense, Enpatorium aromaticum, Polygala Senega, etc. 

To begin with, then, the prescription-writer must endeavor to 
lay aside English and familiarize himself with various Latin verbs 
(most of them in the imperative, or commanding, mood) ; a long list 
of drugs and medicines, to be correctly written and pronounced ; 
a limited number of adjectives, agreeing in gender, case, and number 
with the nouns they qualify ; a few prepositions governing certain 
fixed cases ; and a small number of terms and phrases of general 
importance. Let us consider them seriatim. 

Verbs. 

The first 'item of a prescription is a verb: recipe, "take," the 
sign being 3^. One need not know the conjugation of the Latin 
recipere to understand the import of this order. Such imperatives 
simply signify the instructions of the physician. 

A very few verbs are used in the subjunctive mood, having the 
force of the imperative, such as flat, pi. flant, " let it, or them, 
be made (into, in pilulas) ; or " let be made," as in the ex- 
pression /2dtf mistura, "let a mixture be made"; sufflciat, "may 
suffice," as in the common instruction, abbreviated " q. s.," quantum 
sufflciat, "as much as may be required "; ne repetatur, " do not let 
it be repeated," or " do not repeat "; bulliat, " let it boil." 



PRESCRIPTIONS. 827 

A future passive participle is also frequently used : dividhidus ; 
like an adjective agreeing with the noun in gender, case, and num- 
ber, and signifying " to be divided (into)," as in the order in tro- 
chlscos dividenda (massa), " to be divided into troches," though the 
imperative divide, " divide into," is often used. 

Nouns. 

These form by far the largest vocabulary, including all official 
and nearly all unofficial drugs and medicines, together with -their 
compounds. A considerable number, ending in a, are of the first 
declension, all feminine. 1 Example : 

Singular. 



Nominative. — Ollva 


— Olive (subject) 


Genitive. — Olivae 


— of Olive. 


Accusative. — Olivam 


— Olive (object). 


Ablative. — Ollva 


— with Olive. 


Plural. 




Nom. — Olivae — 


Olives (subject). 


Gen. — Olivarum — 


of Olives. 


Ace. — Ollvas — 


Olives (object). 


Abl. — Olivis — 


with Olives. 



[The Latin dative and vocative cases are never used, and the plural number rarely.] 

An extensive list of medical agents ends in us (generally 
masculine) or um, on (neuter), and are of the second declension. 
(Prinos, masc, is exceptional.) Example : 

Singular. 
Nom. — Oleum — Oil (subject). 
Gen. — Olei — of Oil. 
Ace. — Oleum — Oil (object). 
Abl. — Oleo — with Oil. 

Plural. 
Nom. — Olea — Oils (subject). 
Q en# — Oleorum, Oleum — of Oils. 
Ace. — Olea — Oils (object). 
Abl. — Oleis — with Oils. 

1 The genders of nouns are given as a guide to the agreement of adjectives. 



828 A TEXT-BOOK OF MATERIA MEDICA. 

It may be noted, in passing, that the genitive singular is almost 
exclusively used in prescription-writing. 

We are now prepared to analyze a simple prescription and 
understand its elements. 

Referring to the foregoing examples, suppose we wish the drug- 
gist to supply three drachms of olive oil. We prescribe as follows : 

1^. Olei Olivse 3iij. 

Recipe, Take of oil of olives three drachms. 

It must be borne in mind that the direct object of the imperative 
recipe in this example, as well as in all similar cases, is not the 
medicine oleum, but the amount of it prescribed, as indicated by 
the Roman numerals and the symbol of Apothecaries' weight, 
which, written in full, would be tres drachmas (ace). In this class 
of prescriptions, therefore, including nearly all in use, we need con- 
sider only the genitive, the accusative or grammatical object of the 
verb being expressed in the quantity symbolically indicated. 

It will be noted, moreover, that the construction, or order, of 
the Latin words is the reverse of English usage. Yet it is evi- 
dent that a grocer's clerk, for instance, might well, and frequently 
does, employ the same mode of expression : 

(of) Granulated Sugar lbs 10 — 

a construction precisely analogous to that of the above prescrip- 
tion, which simple form may be taken as a type for all, subject to 
such modifications as the nature of the drug and the treatment 
may require. 

Nouns of the second declension ending in on, all neuter, are of 
Greek derivation, and are declined like oleum. Example : 

Singular. 
Nom. — Toxicodendron. 
Gen. — Toxicodendri. 
Ace. — Toxicodendron. 
Abl. — Toxicodgndro, etc. 

Prlnos, also of Greek origin, is declined: 

Nom. — Prlnos. 
Gen. — Prini. 
Ace. — Prinon. 
Abl. — Prlno, etc. 



PRESCRIPTIONS. 829 

The remaining nouns of the second declension all end in us 
(with four exceptions, masculine), and are declined like the follow- 
ing example : 

Nom. — Juniperus. 

Gen. — Jumperi. 

Ace. — Juniperum. 

Abl. — Junlpero, etc. 

Indeed, all prescription nouns ending in us are of the second 
declension, save seven : 

Nom. Gen. 

Rhus, Rhois, 3d fern. 

Cornus, Cornus, ) , , 

Quercus, Quercus, J 

Fructus, Fructus, a 

Haustus, Haustus, I 

Potus, Potus, } 4 th masc ' 

Spiritus, Spiritus, J 

The four exceptions to the masculine gender mentioned are : 

Juniperus, ^ 

Primus, „ r 

' V all fern, 
bambucus, I 

Ulmus, J 

With these — to be committed to memory — the second declen- 
sion ends, so far as it concerns the prescription-writer. 

While touching upon the fourth declension it may be well to 
complete the study of it, there being but six nouns, ending in us, 
of this declension (Rhus is of the third). They are, as already 
enumerated : 

Cornus, 
Quercus, 
Fructus, 
Haustus, 
Potus, 
Spiritus, 
and are thus declined : 

Singular. 
Nom. — Spiritus. 
Gen. — Spiritus. 
Ace. — Spiritum. 
Abl. — Splritu. 



830 A TEXT-BOOK OF MA TERIA MEDICA. 

Plural. 
Nom. — Spiritus. 
Gen. — Spiritum. 
Ace. — Spiritus. 
Abl. — Spintibus. 
We now come to the third declension, to which belong all 
nouns not included in the foregoing first, second, and fourth, the 
fifth Latin declension, like the dative and vocative cases, not 
being used in prescriptions. All nouns, with seventeen exceptions, 
having terminations other than a (except four), us, um, and on, are 
of the third declension. 

Here the changes from nominative to genitive and other cases 
are quite variable, and may be best remembered by arranging the 
nouns in groups according to their nominative endings, with ex- 
amples of their several declensions. 

Group I. — Thirty-three nouns ending in as make the genitive 
in atis. All are masculine save Asclepias (Gen. Asclepladis), which 
is feminine, and all are names of salts. Example : 

Singular. 
Nom. — Nitras. 
Gen. — Nitratis. 
Ace. — Nitratem. 
Abl. — Nitrate, etc. 
Group II. — 

Nouns ending in is : 
(a) Genitive unchanged ; all feminine. 

Ex. Nom. Cannabis ; Gen. Cannabis. 
{b) Genitive changing into Itis, all masculine. 

Ex. Nom. Arsenis ; Gen. Arsenltis. 
(c) Genitive changing -into idis, all feminine. 

Ex. Nom. Hamamelis ; Gen. Hamamelidis. 
(d) Genitive changing into eris, one only, masculine. 
Ex. Nom. Pulvis ; Gen. Pulveris. 

Group III. — 

Nouns ending in o, all feminine except Carbo, Pepo, and 
Sapo, which are masculine: 
(a) Genitive ending in onis. 

Ex. Nom. Lotio ; Gen. Lotionis. 
(&) Genitive ending in inis. 

Ex. Nom. Mucilago ; Gen. Mucilaginis. 



PRESCRIPTIONS. 831 

Group IV. — 

Nouns ending in x t masculine or feminine : 

(a) Genitive ending in els. 

Ex. Nom. Borax; Gen. Boracis. 

(b) Genitive ending in els, and the last vowel of the nomina- 

tive (e) changed to i. 
Ex. Nom. Rumffi ; Gen. Rumzcis. 

Group V. — 

Nouns ending in r y masculine or neuter : 
Genitive simply adds is. 

Ex. Nom. Liquor; Gen. Liquoris. 

Group VI. — 

Nouns ending in a, all neuter : 
Genitive ends in dtis. 

Ex. Nom. Enema; Gen. Enematis. 

Group VII. — 

Nouns ending in s, masculine or feminine : 
Genitive ends in is. 

Ex. Nom. Adeps ; Gen. Adipis. 

Group VIII. — 

Nouns ending in /, all neuter : 

(a) Genitive simply adds is. 

Ex. Nom. Chloral ; Gen. Chloralis. 

(b) Genitive doubles / and adds is. 

Ex. Nom. Mel ; Gen. Mellis. 

Group IX. — 

Nouns ending in n, all neuter : 

(a) Genitive ending in onis (nominative in on). 

Ex. Nom. Limon ; Gen. Limonis. 

(b) Genitive ending in inis (nominative in en). 

Ex. Nom. Semen ; Gen. Seminis. 
[Engeron has the genitive Erigerontis.] 

Group X. — 

One noun ending in c, neuter : 
Genitive simply adds is. 

Ex. Nom. Lac ; Gen. Lactis. 

In conclusion, there are a number of indeclinable nouns, such 
being all neuter, of various endings and derivations. 



8 3 2 



A TEXT-BOOK OF MATERIA MEDICA. 



Adjectives. 

These are many, and, as has been said, their agreement in 
gender, case, and number with the nouns they qualify is of para- 
mount importance in correct prescription-writing. They are de- 
clined like nouns of different declensions, having the same cases 
and numbers, and may be divided into two classes. 

Class I. includes all but fourteen of the adjectives used in pre- 
scriptions. The nominative has three distinct endings : us, mascu- 
line, declined like the second declension of nouns ; a, feminine, 
declined like the first declension ; and um, neuter, declined like the 
second declension. Example : 

Singular. 





(2d decl.) 


(ist decl.) 


(2d decl.) 




Masc. 


Fern. 


Neut. 


Norn 


Fluidus, 


Fluida, 


Fluidum 


Gen. 


Fluidi, 


Fluidse, 


Fluidi. 


Ace. 


Fluidum, 


Fluidam, 


Fluidum 


Abl. 


Fluido, 


Fluida, 


Fluido. 



Plural. 
Nom. Fluidi, Fluidae, Fluida. 

Gen. Fluidorum, Fluidarum, Fluidorum. 
Ace. Fluidos, Fluidas, Fluida. 
Abl. Fluidis, Fluidis, Fluidis. 

Class II. includes the remaining fourteen adjectives in use. 
These, with few exceptions, have two, instead of three endings : 
one in is for both masculine and feminine genders, and another 
in e for the neuter. Adjectives of this class are declined like nouns 
of the third declension. Example : 



Singular. 




Masc. and Fern. 


Neut. 


Nom. Dulcis, 


Dulce. 


Gen. Dulcis, 


Dulcis. 


Ace. Dulcem, 


Dulce. 


Abl. Dulci, 


Dulci. 


(The form Dulce is sometimes wrongly used for the ablative.) 








PRE SCR IP TIONS. 






Plural. 




Ncm. 


Dukes, 




Dulcia. 


Gen. 


Dulcium, 




Dulcium. 


Ace. 


Dukes, 




Dulcia. 


Abl. 


Dulcibus 




Dulcibus 



&33 



The exceptions in nominative endings are- 



Singular. 







Masc. and Fern. 


Neut. 


(I) 


Nom. 


Effervescens, 


Effervescens. 




Gen. 


Effervescentis, 


Effervescentis. 




Ace. 


Effervescentem, 


Effervescens. 




Abl. 


Effervescente, or -i 
Plural. 


, Effervescente, or 




Nom. 


Effervescentes, 


EffervescSntia. 




Gen. 


Effervescentium, 


Effervescentium. 




Ace. 


Effervescentes, 


Effervescentia. 




Abl. 


Effervescentibus, 
Singular. 


Effervescentibus. 


(2) 


Nom. 


Tricolor, 


Tricolor. 




Gen. 


Tricoloris, 


Tricoloris. 




Ace. 


Tricolorem, 


Tricolor. 




Abl. 


Tricolore, or -i, 
Plural. 


Tricolore, or -i. 




Nom. 


Tricolores, 


Tricolora. 




Gen. 


Tricolorum, 


Tricolorum. 




Ace. 


Tricolores, 


Tricolora. 




Abl. 


Tricoloribus, 

Singular. 


Tricoloribus. 






Masc. and Fern. 


Neut. 


(3) 


Nom. 


Fortior, 


Fortius. 




Gen. 


Fortioris, 


Fortioris. 




Ace. 


Fortiorem, 


Fortius. 




Abl. 


Fortiore, or -i, 


Fortiore, or -i. 



53 



834 A TEXT-BOOK OF MA TERIA MEDICA. 

Plural. 



Nom. Fortiores, 


Fortiora. 


Gen. Fortiorum 


, Fortiorum. 


Ace. Fortiores, 


Fortiora. 


Abl. Fortioribus, Fortioribus. 


Numerals as far as quatuor are declined 


like adjeel 


LIllIldLlOIlb . 

Singular. 




Masc. 


Fern. 


Neut. 


(i) Nom. Unus, 


Una, 


Unum. 


Gen. Unius, 


Unius, 


Unius. 


Ace. Unum, 


Unam, 


Unum. 


Abl. Uno, 


Una, 


Uno. 


Plural. 




(2) Nom. Duo, 


Duae, 


Duo. 


Gen. Duorum, 


Duarum, 


Duorum. 


Ace. Duos, 


Duas, 


Duo. 


Abl. Duobus, 


Duabus, 


Duobus. 


Plural. 




Masc. 


Fern. 


Neut. 


(3) Nom. Tres, 


Tres, 


Trta. 


Gen. Trlum, 


Trlum, 


Trlum. 


Ace. Tres, 


Tres, 


Tria. 


Abl. Tribus, 


Tribus, 


Tribus. 



[The ordinal numbers, primus, secundus, tertius, etc., are not 
used in prescription-writing.] 



Conjunctions — Adverbs. 

Conjunctions are rare, except it, and. Adverbs are very seldom 
employed. 

Prepositions. 

Three prepositions govern the accusative case: ad, to, up to; 
in, into ; and supra, upon. Others are rarely used. 

Two prepositions, oftenest used, govern the ablative case : cum, 
with, and pro, for. 



PRESCRIPTIONS. 835 

Words and Phrases. 

[In the following list accepted usage rather than rigid adherence to Latin quantity has in a few 
instances appeared advisable. One would hardly insist upon seme I, tere, bene, (semmel, terry, benny) 
in place of the customary long vowel sounds, though the former are obviously in accordance with 
Latin prosody.] 

Ad libitum, at pleasure. 
Ad saturdndum, to saturation. 
Ana, aa, of each. 
. Bene, well, 
Bis, twice. 

Bis indies, twice a day. 
Clbus, food. 

Cochleare medium, a dessertspoon(ful). 
Cochleare magnum, a tablespoon(ful). 
Cochleare pdrvum, a teaspoon(ful). 
Collutorium, a mouth-wash. 
Dein, afterward. 
Dimldius, half. 
Dosus, a dose. 
Et, and. 

Extende supra, spread upon. 
Gradatim, gradually. 
Gutta, a drop. 
Guttatim, drop by drop. 
Hora, an hour. 
In dies, daily. 
Lagena, a bottle. 
Libra, a pound. 
Llnteum, lint. 
Mane, in the morning. 
Mane prlmo, early in the morning. 
Mica panis, a breadcrumb. 
Non, not. 
Node, at night. 
Numerus, a number. 
Numero, in number. 
Octarius, a pint. 
Pdrtes cequales, in equal parts. 
Pro re natd, as required. 

Quantum sufflciat, q. s., as much as is necessary. 
Quaqua hora, every hour. 
Saturatus, saturated. 



836 A TEXT-BOOK OF MA TERIA MEDICA. 

Scatula, a box. 

Semel, once. 

Semlssis, ss., a half. 

Semidrachma, half a drachm. 

Slmul, together. 

Sine, without. 

Statim, immediately. 

Tales, such. 

Tales doses, such doses. 

Tere slmul, rub together. 

Ter In die, three times a day. 

These complete the list of Latin parts of speech, conjugations, 
declensions, etc., with which the prescription-writer is likely to be 
concerned. 

Thercare niceties of Latin construction which, to one acquainted 
with that idiom, will readily occur in scanning the order of words in 
certain medicinal compounds. Having the sanction of professional 
usage, the departure from the classic arrangement is of slight 
importance, and it is certainly in accordance with the clearer, more 
direct English form. Instance the construction in what are known 
as " Galenical Preparations " (an objectionable adjective, by the 
way, being at variance with the rules of etymology, since the c of 
the derivative is wanting in the parent word Galen). In writing 
these the nominative — Unguentum, Mistura, Tinctura, etc. — is 
placed first, as, Unguentum Zinci Oxidi, etc. Oleum Morrhuse 
is also an example, and others are not uncommon, apart from the 
Galenical order. 

The practical difficulties in writing prescriptions correctly are 
largely eliminated by the almost exclusive use of the genitive. Yet 
it is necessary to understand clearly the use of the accusative in all 
cases where the medicine is prepared from the mass according to 
certain established formulae, and moulded in certain forms, if not 
already prepared, as in the condition of pills, troches, etc., which 
are the immediate object of the imperative recipe, and cannot be 
placed in the genitive. 

Example : 

Ify. Pilulas (not Pilularum) Ferri Iodidi (a number). 

Where the mass is mentioned or implied in the prescription, the 
general rule of the genitive is followed, as : 1^. Ungugnti Bella* 



PRESCRIPTIONS. 837 

donnae (a portion) ; and where the terms flat, f lant are expressed, 
the nominative is naturally used, as, for example, 

1^. Massae hydrargyri, gr xxx ; 

Flant pilulae No. x. 
Sig. Take one at bed-time. 

Here pllulce is the subject of the Latin irregular verb signifying 
" to be made," no case save the nominative being admissible. 

It has been presumed in the foregoing pages that all prescrip- 
tions are to be written in full — a practice which, could it meet with 
universal acceptance, would not infrequently be of vital importance 
alike to patient and practitioner. Custom, however — and in certain 
cases advantageously — has authorized the extensive use of abbrevia- 
tions, although the dangers of carelessness or ignorance in their 
employment will be apparent if we consider that, for example, 
Ammon. may mean either Ammonia or Ammoniacum ; Chlor., 
Chlorum, Chloral, Chloroformum, Chloras, or Chloridum ; Hyd. 
Chlor., Hydrate of Chloral or Hydrargyri Chloridum Corrosivum 
or Mite ; Sulph., Sulphur, Sulphas, Sulphidum, or Sulphis ; Zinc. 
Phos., Zinci Phosphas or Zinci Phosphidum. 

These are but few of the many instances of ambiguity occa- 
sioned by inadvertence or want of familiarity with the full Latin 
form, or at least its recognized and unmistakable abbreviation. 

In conclusion, let the writer of prescriptions be warned against 
too great haste and a chirography which none but its author can 
decipher — a deficiency for which he alone is responsible, though 
the onus may fall upon the luckless druggist or his bewildered 
clerk. 

With regard to form, it has been our object to show that there 
is really little difficulty in writing good prescription Latin, and 
where the slightest chance of error exists the ampler expression, as 
we have strongly urged, should be used. A clear, business-like 
method, deliberately chosen and consistently pursued, will render 
this important item of the physician's labor simple, agreeable, and 
efficient. 

It is necessary not only that the directions to the patient should 
be written in perfectly legible English and in full, but that they 
should contain the exact dose, time for, and method of taking, and, 
in short, every detail which it may be advisable for the patient and 
nurse to know, clearly and intelligibly expressed. A physician is 



838 A TEXT-BOOK OF MATERIA MEDICA. 

seldom justified in writing merely "As directed," the full directions 
being the only clue to the safety of the medicine. Moreover, 
verbal instructions to the patient or attendant may be partially or 
even wholly forgotten, or confounded with directions relating to 
other matters connected with the case, and thus the welfare of the 
patient be endangered. 

All preparations intended for external or local application or for 
injections should be marked accordingly, " For External Use," etc. ; 
and if the agent be a poisonous mixture, a " Not-to-be-taken " label 
should be attached to the bottle. If a mixture is ordered contain- 
ing an insoluble substance, a " Shake-well " label should be used. 

Should it be necessary to prescribe an extraordinary dose of 
some powerful drug, the name of the remedy should be under- 
scored or attention called to it by a X, referring to the bottom of 
the prescription, where should be written : " Large dose intended," 
or " Dose of above correct," or something to indicate to the phar- 
macist that the writer is fully aware of the unusual amount, and 
thus save delay in consulting with the physician — which a careful 
and competent druggist would otherwise do. Should it, in the 
opinion of the physician, be undesirable to repeat the prescription, he 
should write at the bottom, " Do not repeat," or the customary 
Latin, " Ne repetatur." 

Every prescriber should be supplied with suitable prescription- 
blanks arranged in the form of pads conveniently carried in the 
pocket, a suitable size being four by five inches. The paper should 
be of linen, of good quality; otherwise it is liable to become 
detached from the druggist's files and lost. A convenient form of 
pad is composed of prescription blanks with interleaves and copy- 
ing paper, so that the physician may always retain an exact record 
of the remedies ordered for his patient. 

It is certainly advisable for the physician to write his prescrip- 
tions invariably in ink, since pencil is easily erased, and a pre- 
scription thus perishable would be of little use in medico-legal 
emergencies. Besides, an unscrupulous druggist who had been 
careless in compounding the remedy might easily change the pencil 
instructions to conform to his mistake. Finally, the pencil-writing 
is always liable to be erased or partially obliterated when carried 
for some time or subjected to frequent handling. 

The prescription-blank should have printed neatly upon one 
margin or the back the physician's residence and office, together 
with hours for consultation, and telephone number if he has one. 



PRESCRIPTIONS. 839 

This advertises the physician to some extent in a legitimate way, 
besides enabling the patient or druggist to communicate with him 
readily if necessary. 

It is a matter of personal taste whether the druggist's name 
should appear upon the blank. Considerations of courtesy and the 
possible event of loss or of legal contingencies may weigh with 
some practitioners, though others are of the opinion that it is un- 
desirable to print anything on the blank save the physician's name, 
office, hours, and telephone number. 

The prescription should always be signed by the writer in full, 
that professional responsibility and identity may be assured, the 
academic " M. D." being preferable as a title to " Dr.," which is 
applicable to various professions — often of questionable repute and 
authenticity. 

In concluding these practical hints, the author cannot too 
strongly impress upon the student the importance of always writing 
as clear, legible, complete, and classical a prescription as possible. 
In a new community the reputation of the recent graduate is often 
dependent upon the character of the prescription he writes. The 
druggist invariably scans his instructions from the new doctor criti- 
cally, and the laity and the profession will soon learn the young 
aspirant's proficiency or ignorance by his public committal in a pre- 
scription. No matter how able a diagnostician, pathologist, or bac- 
teriologist he may be, if his first effort in prescription-writing be 
illegible, poor Latin or for a hopelessly incompatible mixture, the 
druggist will label, classify, and measure him with the keenness of 
professional insight ; the judgment will go forth quietly ; and years 
of successful practice may not serve to eradicate that first unfavor- 
able impression. 



840 RELATION OF PHYSICAL CHEMISTRY 



THE RELATION OF PHYSICAL CHEMISTRY 

TO 

PHARMACOLOGY AND THERAPEUTICS. 



Perhaps no departments of medicine have been so subject to 
the criticism " unscientific " as those of pharmacology and thera- 
peutics. A momentary glance at the facts in the case suffices to 
show that this criticism is far from unjustified. Pharmacologists 
still hold the most contradictory positions regarding the action of 
specific drugs ; and therapeutists have at their disposal but few 
means which enable them to predict with definiteness the course 
of disease. In the main, therapeutics has rested upon empiricism, 
while a scientific basis for its proceedings has been deplorably con- 
spicuous by its absence. Our modern therapeutic nihilism is 
undoubtedly the reaction of a thinking medical profession against 
this antiquated empiricism. But, as is customary with such reac- 
tions, the pendulum has swung too far backward. In order to re- 
store it to its right position it is necessary that we reconstruct our 
knowledge of pharmacology and therapeutics, and, by beginning 
with its simplest problems, slowly rebuild it upon a scientific basis. 

It is impossible, in this limited space, to even touch upon all the 
points at which physical chemistry offers immediate results in its 
application to the problems of pharmacology. In these pages, 
therefore, we shall consider only the applicability of the theory of 
electrolytic dissociation to the problems in hand. 

According to the dissociation theory of Arrhenius, when strong 
acids, bases, or salts are dissolved in water (or certain other 
solvents), either all or a part of the molecules are split by the 
water into simpler substances — the electrically charged atoms or 
groups of atoms known as " ions." Since these strong acids, 
bases, and salts upon solution conduct the electric current, they 
are known as " electrolytes." According to Arrhenius' theory t 
then, a solution of hydrochloric acid is made up not only of HC1 
molecules, but also of H-ions and Cl-ions. Similarly, a solution 
of sodium hydroxide contains not only molecules of NaOH, but 
also Na-ions and OH-ions. Ions are charged with positive or 
negative electricity. The negatively charged ions, which travel to 



TO PHARMACOLOGY AND THERAPEUTICS. 841 

the positive pole, are termed " anions " ; those charged with positive 
electricity, and traveling toward the negative pole, are termed 
" kations." Thus the ions of a completely dissociated hydro- 
chloric acid solution may be written H + and C1-. 

We cannot here bring forward even a few of the facts that go 
to prove the truth of the dissociation theory of Arrhenius ; but 
there are an abundance of the same to show that the chemical 
(and consequently the physiological, pathological, and pharmaco- 
logical) effects of most of the electrolytes are entirely dependent 
upon their constituent ions, and are independent of the nature of the 
molecules. For example : hydrochloric acid dissociates into H- 
and Cl-ions ; NaCl dissociates into Na- and Cl-ions. These solu- 
tions are the same in so far as they both contain Cl-ions, but dif- 
ferent in that one contains H- and the other Na-ions. These 
differences determine the differences in the properties of the two 
solutions. 

A single experiment may serve to fix more clearly the fact that 
it is, indeed, the ions, and not the molecules, that determine the 
activity of an electrolyte in solution. If an iron nail is put into an 
aqueous solution of HC1, the iron is immediately attacked and H 
is liberated. If, however, the nail is put into a solution of HC1 in 
benzene, no such chemical action takes place. The water in the 
first case converts the HC1 into H- and Cl-ions. Benzene has 
practically no such dissociating powers, and the HC1 remains in 
the molecular state. The molecules of HC1 are incapable of 
attacking the iron. 1 

It may, then, be accepted as true in general that the chemical 
characteristics of an electrolyte are dependent upon the nature of 
the ions contained therein. Thus the chemical characteristics of 
an aqueous solution of HC1 are determined by the H- and Cl-ions 
it contains. All acids yield H-ions, and it is because of this fact 
that all acids have certain general properties. The differences 
between the solutions of two different acids that contain the same 
number of H-ions are determined by the differences between their 
anions. Since, now, the physiological effects of a substance are 
dependent upon its chemical nature, and since the chemical nature 
of an electrolyte is, in the main, dependent upon the nature of its 
ions, it follows that the physiological effects of an electrolyte are 
determined by the nature of its ions. 

When an electrolyte is administered as a therapeutic agent, 
before it can produce any effect it must be in solution. Water is 



842 RE LA TION OF PHYSICAL CHEMISTRY 

the universal solvent in the body. But when an electrolyte is dis- 
solved in water, it is dissociated into ions. The therapeutic effects 
of such an electrolyte must, then, be dependent upon the ions 
which it yields. For example, in the administration of a dose of 
sodium iodide, we deal not with the effects of the Nal molecules, 
but with the effects of the Na- and I-ions into which the sodium 
iodide dissociates. I shall prove the truth of this claim later on. 

Although Dreser showed in 1894 that the relative toxicity of 
the mercury salts is determined by the number of Hg-ions that 
the salt yields upon solution in water, and although Kahlenberg 
and True were the first to show that the poisonous effects of 
various electrolytes upon the roots of the bean are determined by 
the nature of their ions, the credit of recognizing the widespread 
physiological importance of the theory of electrolytic dissociation 
belongs to Jacques Loeb. 

A series of papers originating from the . laboratory of this 
investigator have brought proof of the following facts. The 
poisonous effects of acids and alkalies 2 upon muscle are deter- 
mined by the number of the H- and OH-ions they yield, and is 
independent of the nature of the acid (in the case of the inorganic 
acids) or alkali. Another paper 3 shows that the amount of water 
absorbed by a muscle from equimolecular salt solutions is in- 
fluenced not only by the laws of osmotic pressure, but also by the 
nature of the ions in the solutions. The absorption of water from 
equimolecular solutions of sodium, potassium, and calcium salts 
by muscle is analogous to the absorption of water by the Na-, K-, 
and Ca-soaps, for while muscle absorbs but little water in the 
sodium solution, it absorbs an enormous amount in the potassium 
solution, while it actually loses water in the calcium solution. A 
most important contribution to our knowledge of life phenomena 
is found in the discovery that Na-ions are absolutely necessary for 
the production of rhythmical contractions in voluntary muscle, 4 in 
heart muscle, 5 and in the contractile swimming bell of the medusa. 6 
Yet a heart beating rhythmically in a pure sodium chloride solu- 
tion soon comes to a standstill. If, however, a little calcium be 
added, the heart may continue to beat for hours. 

What bearing, now, has the theory of electrolytic dissociation 
upon the problems of pharmacology? We have for years been 
accustomed to see the effects of different salts grouped under 
general headings. Thus we have become acquainted with the 
general effects of potassium and sodium salts, the salts of iron and 



TO PHARMACOLOGY AND THERAPEUTICS. 843 

lead, and the general properties of iodides and bromides. Never, 
however, has the question been asked, Why do these salts arrange 
themselves in such groupings ? We have learned that certain salts 
having certain characteristics in common may at will be substituted 
for one another. We have known, moreover, that although certain 
groups of salts, such as the salts of Hg, Ag, Pb, Cu, etc., all have 
highly poisonous properties, yet that the fatal dose of the individual 
members of such groups differs greatly from one another. Then 
we have been impressed with the fact that many organic salts, or 
salts combined with organic substances, are either entirely without 
effect, or else behave entirely differently from the ordinary salts. 
These are a few of the facts which become at once intelligible in 
the light of the dissociation theory. 

We have said before that in the process of solution an electro- 
lyte is dissociated, and that in consequence we deal, in the main. 
no longer with the properties of its molecules, but of the ions that 
constitute the molecules. We know, for example, that we can 
substitute, at will, sodium iodide for potassium iodide in order to 
produce certain therapeutic effects. These salts are alike in that 
they both yield I-ions ; they differ in that the former yields Na- 
ions, while the latter yields K-ions. Any similarity manifested in 
the therapeutic effects of these two salts is determined by the 
similarity of their anions. But we know that the potassium iodide 
is much more depressant than the sodium salt. This is due to the 
direct poisonous effects of the K-ions upon muscle and nerves, an 
effect not exhibited by Na-ions. It is because all the iodides yield 
I-ions that they are grouped under a general heading. It is the 
effect of the I-ions that we seek in administering this drug in 
syphilis. Provided we give equal doses of I-ions, one salt may at 
will be substituted for the other. It is the secondary benign or 
deleterious action of the kations, however, which determines 
which salt we employ. 

Similar reasoning applies to the bromides. We have long 
known of the hypnotic effects of the bromine salts and the specific 
effects of the bromides in epilepsy. These effects are due to the 
Br-ions, and one salt is as good as the other, provided it yields the 
same number of Br-ions, and its good qualities arc not offset by a 
deleterious action of the kations. Experience with the bromides, 
moreover, brings to light the fact that it is indeed the Br4ons that 
determine the desirable effects of bromine compounds. Clinicians 
have long been acquainted with the fact that organic compounds 



844 RE LA TION OF PHYSICAL CHEMISTRY 

containing bromine do not produce the effects given by the inor- 
ganic salts. This is because these organic compounds containing 
bromine do not yield any Br-ions at all, or because they yield only 
such small quantities as to be without effect in the doses adminis- 
tered. The same facts explain why manufacturers have been 
unsuccessful in producing an organic compound of bromine which 
could at all rival the ordinary inorganic salts. 

The theory of electrolytic dissociation also explains why iron 
salts have certain general characteristics possessed by no other 
salts, and why the salts of Hg, Ag, Pb, Cu, etc., are classed in 
groups by themselves. In these instances, however, the charac- 
teristic activity of the salt is determined by the kations, for the 
effects of the Hg-ions, Pb-ions, etc., evidence themselves long 
before the effects of the anions spring into prominence. In the 
cyanides, again, the anions are the effective agents and determine 
the characteristics of their group. KCN and HCN show similar 
effects, perhaps, because they both yield CN-ions, and these mani- 
fest their effects in doses so small that sight is lost of the K- and 
H-ions. 

Eight years ago Dreser 7 showed that the toxic effects of mer- 
cury salts are determined by the number of Hg-ions they yield 
upon solution. When mercuric chloride is added to albumin a 
precipitate is formed which can be readily dissolved in sodium 
thiosulphate, forming a so-called complex mercury salt. When 
the mercury exists in this complex form it loses its toxic proper- 
ties, and even though equal weights of the metal be present, the 
complex salt is unable to inhibit fermentation ; and frogs, fishes, 
etc., poisoned with it instead of the sublimate die more slowly. 
Dreser finds an explanation for these phenomena in the fact that 
the double salt is either not dissociated at all, or yields only a 
small number of Hg-ions. In cold-blooded animals the salt is 
slowly decomposed, and the toxic effects of Hg-ions formed 
poison the animal. In warm-blooded animals the decomposition 
occurs much more rapidly, and in consequence not much differ- 
ence was found between the toxic effects of the mercuric salt and 
its more complex derivative. Yet all local irritative manifestations 
were lacking in the latter case. 

There have recently appeared upon the market various organic 
compounds of silver (protargol, nargol, etc.) which have come into 
general use as substitutes for silver nitrate. It seems that these 
compounds exhibit all the beneficent and only a few of the 



TO PHARMACOLOGY AND THERAPEUTICS. 845 

deleterious qualities of silver nitrate. Undoubtedly an explana- 
tion similar to that given by Dreser holds here too. Silver nitrate 
owes its specific action to the Ag-ions it yields. The organic 
silver compounds probably yield none or only a small number of 
such ions. When, however, the organic compound is introduced 
into the body, it is decomposed, and the Ag exerts its specific 
effects to a degree dependent upon the number of Ag-ions 
liberated. These facts explain the differences in the behavior 
between the organic and the inorganic silver salts. 

Paul and Kronig, 8 and, more recently, Scheurlen and Spiro, 9 
have been able to show that the bactericidal power of solutions of 
electrolytes is dependent upon the ions contained in them. Equi- 
molecular solutions of mercury salts arrange themselves according 
to their degrees of electrolytic dissociation in the following order : 
HgCl 2 , HgBr 2 , Hg(CNS) 2 , Hgl 2 , HgCy 2 . When arranged accord- 
ing to their bactericidal powers, the order is the same. This power 
is then dependent upon the number of Hg-ions contained in the 
solution. HgCl 2 , which contains the largest number, has the 
strongest germicidal action, while HgCy 2 , which is least disso- 
ciated, has the feeblest. So weak is the action of the cyanide that 
at a concentration four times that of a bichloride solution capable 
of destroying all cocci and spores it permits the development of 
several thousand colonies of the staphylococcus and many colonies 
of the anthrax bacillus. If K-ions are substituted for the Hg-ions 
by the substitution of KC1 for HgCl 2 in the antiseptic solution, the 
germicidal powers of the solution are decreased, another fact which 
proves that the Hg-ion is the specific germicide. These facts 
effectively dispose of the conception of Behring, still held by 
many, that the bactericidal power of a mercurial is dependent upon 
the amount of mercury contained in it, and is independent of the 
nature of the compound. 

The germicidal effects of silver and gold salts are similarly 
found to be dependent upon the Ag- and Au-ions. That it is, 
indeed, the ions which are thus effective is proved by the fact that 
solutions of HgCl 2 or AgN0 3 in absolute alcohol or ether (solvents 
in which but slight dissociation occurs) have no deleterious effect 
upon anthrax spores. 

Recently Loeb 1011 has pointed out the influence of the valency 
and possibly the electrical charge of ions upon their toxic and 
antitoxic effects. Previous experiments had brought to light the 
poisonous character of a pure sodium chloride solution for the 



846 RELA TION OF PHYSICAL CHEMISTR Y 

development of fish embryos, or on the beat of the heart. But these 
toxic effects are done away with when a small amount of calcium 
is added to the sodium chloride solution. Thinking that these 
were only special instances of a more general law, Loeb inves- 
tigated the toxic and antitoxic effects of ions upon the develop- 
ment of the eggs of Fundulus, a marine fish. The eggs of this 
fish develop equally well in sea-water (their ordinary habitat), in 
distilled water, or in sea-water the concentration of which has been 
raised by the addition of NaCl. In a pure sodium chloride solu- 
tion, however, of the same concentration as that of the sea-water, 
not a single embryo develops. If, now, a small though definite 
amount of a calcium salt be added, the poisonous effect of the 
NaCl solution is annihilated, and the eggs develop into embryos. 
Not only is calcium able to bring about this effect, but any bivalent 
kation serves the same purpose — Ca, Ba, Mg, Fe, Co, and even 
Zn and Pb. The nature of the anion is immaterial. 

But these facts hold not only for the poisonous effects of a pure 
NaCl solution, but also for the poisonous effects of solutions of 
other salts, of univalent kations with univalent anions — LiCl, KC1, 
NH 4 C1. From these experiments, then, the general conclusion 
may be drawn that a small amount of a bivalent kation suffices to 
annihilate the poisonous effects of the pure solution of a salt com- 
posed of a univalent kation with a univalent anion. It has been 
further shown that a trivalent kation may at will be substituted for 
the bivalent kation, and that a much smaller amount of a trivalent 
kation (Cr, Al) suffices to annihilate the poisonous effects of a 
pure sodium chloride solution than is required of the bivalent 
kation. Finally, a quantitative relation exists between the amount 
of the toxic salt and the amount of a bivalent kation necessary to 
annihilate its poisonous effects. With an increase in the concen- 
tration of the pure NaCl solution there is a corresponding increase 
in the minimal amount of the bivalent kation necessary to do away 
with its toxic effects. 

These facts are of the greatest biological significance and of the 
most wide-spread applicability. A preliminary note announces 
that the valency and possibly the electrical charge of ions in- 
fluence in a similar way the toxic effects of pure salt solutions 
upon muscle. The effect of a calcium salt in overcoming the 
poisonous effects of a pure sodium chloride solution upon the 
rhythmical contraction of a heart muscle strip becomes at once 



TO PHARMACOLOGY AND THERAPEUTICS. 847 

intelligible as a specific instance of the above-mentioned general 
law. 

Loeb's experiments give us an insight, moreover, into the 
method by which ions possibly influence protoplasm. Three 
years ago he pointed out the fact that in dealing with the proper- 
ties of protoplasm we are dealing, in the main, with the physics of 
a colloidal solution in which are dissolved certain salts. The ex- 
periments of Hardy have demonstrated most clearly the influence 
of the electrical charge of ions upon the physical state of colloidal 
particles. It requires a large amount of a univalent ion to cause 
the coagulation of a colloid, but a small amount of a bivalent, or a 
still smaller amount of a trivalent, ion will accomplish the same 
purpose. Loeb believes that similar facts may possibly underlie 
the toxic and antitoxic effects of the salts. If the electrical charge 
determines the antitoxic effects of a kation, then it becomes at 
once apparent why a small amount of a bivalent, or a still smaller 
amount of a trivalent, positively charged kation suffices to neu- 
tralize the poisonous effects of a pure sodium chloride solution. 

I believe that the foregoing few facts suffice to show that it 
cannot be long before an entirely new analysis of the action of 
drugs will have to be made. Pharmacology has acquainted 
itself fairly well with the superficial attributes of drugs, and it is 
time that it ask itself the question, Why or how do they bring 
about these effects ? Perhaps we cannot yet hope to find an 
answer to this question when applied to the action of alkaloids, 
glucosides, oils, and other complex organic compounds, but the 
possibility of rearranging, classifying, and simplifying our knowl- 
edge of the pharmacology of the electrolytes is certainly at hand. 

The theory of electrolytic dissociation is only one of the many 
developments of physical chemistry that promises much if applied 
to the problems of pharmacology or the biological sciences in 
general. We must attribute a large part of our present ignorance 
concerning the general laws that underlie the action of drugs to 
the failure to recognize and utilize the fruits of this new science. 
Innumerable papers still appear in which the physiological, patho- 
logical, and pharmacological effects of percentage solutions of 
various electrolytes are compared. Only chemically equivalent 
solutions can be compared. It is to such violations of the simple 
laws of physical chemistry that many of the erroneous results 
obtained in the biological sciences are to be attributed. 



848 RELA TION OF PHYSICAL CHEMISTR Y. 

The action of electrolytes must be analyzed into the action of 
their constituent ions. Ultimately we shall have a classification 
of the electrolytes based upon the action of the ions contained in 
them. Once we grasp the notion that the activity of a given sub- 
stance is determined by the ions it yields upon solution we shall, 
perhaps, find a method of rearranging our system of dosage upon 
this basis — a process analogous to the regulation of the dosage of 
crude drugs based upon their alkaloid content. 

REFERENCES. 

1. See Fischer, Medical Record, 1901, March 30, where a review of the literature 
in its application to physiology and pathology is given in greater detail. 

2. Loeb, Pfluger* s Arch., 1897, lxix., p. I. 

3. Loeb, ibid., 1899, lxxv., p. 303. 

4. Loeb, "Beitrage zur Physiol ogie," Festschr. f. A. Fick, 1899, p. IOI. 

5. Lingle, Am. Jour. Physiol., 1900, iv., p. 265. 

6. Loeb, ibid., 1900, Hi., p. 383. 

7. Dreser, Arch. f. exp. Pathol, u. Pharmakol., 1893, xxxii., p. 456. 

8. Paul and Kronig, Zeitschr. f. physik. Chetn., 1896, xxi., p. 414. 

9. Scheurlen and Spiro, Munchener med. Wochenschr., 1897, xliv., p. Si. 

10. Loeb, PJUlger" 1 s Arch., 1 901, lxxxviii., p. 68. 

11. Loeb, Am. Jour. Physiol., 1902, vi., p. 41 1. 






GENERAL INDEX 



Note. — The bold-face figures indicate the pages on which the drugs are treated 
in exienso. 



■ Absolute alcohol, 586 
Abstracta, 109 
Abstracts, 109 
Acacia, 800, 806 
Aceta, 95 
Acetanilid, 408 
Acetanilidum, 408 
Acetic acid, 159 
glacial, 785 

ether, 432 
Acetone chloroform, 436 
Acetum opii, 453 

sanguinarise, 282 

scilla, 661 
Acid phosphates, 66 
Acidum aceticum, 159 
dilutum, 159 
glaciale, 797 

arsenosum, 252 

benzoicum, 353 

boricum, 363 

camphoricum, 401 

carbolicum, 323 
iodatum, 324 

chromicum, 795 

citricum, 159 

gallicum, 739 

hydrobromicum dilutum, 555 

hydrochloricum, 150 
dilutum, 150 

hydrocyanicum dilutum, 545, 766 

hypophosphorosum dilutum, 219 

lacticum, 157 

nitricum, 152 
dilutum, 152 

nitrohydrochloricum, 151, 152 
dilutum, 151, 152 

phosphoricum, 151 
dilutum, 151 

salicylicum, 334 

sulphuricum, 151 
aromaticum, 151 
dilutum, 151 

sulphurosum, 373 

tannicum, 735 

tartaricum, 160 
Aconite, 602 
Aconitine, 603 
Aconitum, 602 
Actol, 772 
Adeps benzoinatus, 353 

H 



Adhesive plaster, 136 
Adonis vernalis, 575 
Adrenalin, 235 
Aerotherapy, 24 
y£ther, 421 

Albuminate of iron, 203 
Alcohol, 585, 628, 783 

absolutum, 586 

deodoratum, 586 
Alcoholic extract of belladonna leaves, 477 

eye-wash, 71 
Ale, 588 

Alkali solutions, 66 
Alkalies, 162, 641 
Alkaline salt solutions, 65 
Allium, 645 

cepa, 645 
Allspice, 390 
Almond, 800 

oil, 800 
Almonds, comp., 115 
Aloe, 698 

barbadensis, 698 

purificata, 699 

socotrina, 699 
Aloes, 698, 728 
Aloin, 700 
Aloinum, 700 
Alpha, 523 
Alsol, 774 
Althaea, 808 
Alum, 735, 773 

(burnt), 773 
Alumen, 773 

exsiccatum, 763 
Alumini hydras, 774 

sulphas, 774 
Aluminis glyceritum, 773 
Aluminum aceto-tartrate, 774 

boroformate, 774 

hydrate, 774 

sulphate, 774 
Alumnol, 342, 343, 773 
American hellebore, 606 

wormseed, 720 
Ammonia, 783 

(confined vapor), 785 

liniment, 599 

water. 599 
Ammoniac, 400 

plaster with mercury. 24 1 , 400 

B49 



S 5 o 



GENERAL INDEX. 



Ammoniacum, 400 
Ammoniated glycyrrhizin, 647 
mercury, 240 
tincture of guaiac, 277 
of valerian, 402 
Ammonii benzoas, 354 
bromidum, 553 
carbonas, 170, 599 
valerianas, 402 
Ammonio-ferric alum, 199 
sulphate, 199 
tartrate, 199 
Ammonium, 628 
benzoate, 354 
bromide, 554 
carbonate, 170, 599 
chloride, 641, 642 
iodide, 263 
iodidum, 263 
valerianate, 402 
Amyl nitras, 549 

nitrate, 549, 628 
Amylene hydrate, 435 
Anemonin, 612 
Anesthesia, cyanosis in, 426 
pulse in, 426 
respiration in, 426 
spinal, 522 
Anesthetics, 418 

Anhydro-ortho-sulphamin-benzoic acid, 68] 
Aniline iodine, 350 
Animal charcoal, 801 

extracts, 231 
Anise, 379 

water, 380 
Anisum, 379 
Anthelmintics, 719 
Anthemis, 185 

Antimonii et potassii tartras, 630 
Antimony and potassium tartrate, 626, 630, 

641 
Antipyrine, 412 
Antiseptol, 348 
Antispasmodics, 399 
Antistreptococcic serum, 315 
Antitoxins, origin of, 295 
Apiol, 728, 733 
Apiolum, 733 
Apolysin, 417 
Apomorphine, 641 

hydrochlorate, 626 
Aqua acidi carbolici, 323 ' 
ammoniae, 599 
fortior, 598 
anisi, 380 
camphorae, 401 
chlori, 375 
chloroformi, 427 
cinnamomi, 382 
creosoti, 330 
eucalypti, 360 
fceniculi, 384 
hydrogenii dioxidi, 37 1 
menthae piperitse, 395 



Aqua menthae viridis, 396 

picis liquidae, 648 
Aquae medicatae, 64 
Aqueous fluid extract of senna, 107 
Argentamine, 771 
Argenti cyanidum, 766 
iodidum, 266, 766 
nitras, 767 

dilutus, 615, 767 
fusus, 767 
oxidum, 767 
Argentol, 771 
Argonin, 771 
Aristol, 349 
Arnica, 783 
flowers, 613 
plaster, 613 
radix, 613 
root, 613 
Arnicae flores, 613 
Aromatic bitters, 185 
powder, 381, 391 
of chalk, 167 
and opium, 167 
spirit of ammonia, 599 
sulphuric acid, 151 
syrup of rhubarb, 703 
tincture of rhubarb, 702 
waters — official, 64 
Aromatics, 377 

volatile oils of, 378 
Arseni iodidum, 253 
Arsenic iodide, 253 
solutions, 65 
trioxide, 252 
Arsenous acid, 252 
Asafetida, 399, 728 
Asaprol, 342, 343 
Asparagin hydrargyrate, 244 
Aspergillus oryzse, 145 
Aspidium, 719, 720, 723 
Aspidosperma, 541 
Aspidospermine, 542 
Astringents, 734 
Atropa mandragora, 478 
Atropina, 477 
Atropinae sulphas, 478 
Atropine, 477 

compared with morphine, 482 
sulphate, 478 

Bacilli, 126 

Balsam of copaiba, 671 

of Peru, 358 

of tolu, 641, 644 
Balsamum Peruvianum, 358 

tolutanum, 644 

tranquillans, 130 
Bandages — antiseptic dressings, 138 
Barbadoes aloes, 698 
Barker's pills, 124 
Barley, 800 
Basham's mixture, 65 
Basic mercuric sulphate, 244 






GENERAL INDEX. 



851 



Basilicon, 134 


Black pepper, 387 


Bateman's pectoral drops, 102 


wash, 244 


Baths, 728 


Blackberry, 749 


Battery-fluid, 67 


aromatic, 77 


Bay rum, 70 


cordial, 84 


Bearberry, 664 


Bland oils, 800 


Beef and wine, 96 


Blaud's pills, 122, 203 


wine, and iron, 96 


Blistering cerate, 133 


wine, iron, and cinchona, 97 


collodion, 130, 786 


Beer, 588 


paper, 137 


Belladonna, 684 


Blood-root, 282 


leaves, 476 


Blue cohosh, 731 


liniment, 477 


flag, 704 


ointment, 477 


mass, 119, 240 


plaster, 477 


ointment, 132, 240 


root, 477 


pill, 240 


Belladonnse folia, 476 


Bolus, 126 


radix, 477 


Bone-marrow, 238 


Benzanlid, 355 


Boracic acid, 363 


Benzoate of bismuth, 355 


Boral, 774 


of menthol, 355, 395 


Borax, 363, 728, 729 


Benzoated lard, 353 


Bougies, 135 


Benzoic acid, 353 


Boulton's solution, 67 


Benzoin, 353 


Bran, 800 


Bonzoinum, 353 


Brandy, 70, 586 


Benzonaphtol, 342, 343 


Brayera, 725 


Benzo-naphthol, 355 


Bread, 800 


Benzosal, 355 


Bromide of iodine, 266 


Benzosol, 332 


Bromides, 553, 628 


Benzoylecgonine, 523 


Bromine, 799 


Benzoyl-eugenol, 389 


Bromoform, 555 


Benzoyl-sulphonic-imide, 681 


Bromum, 799 


Bestucheff' s tincture, ioi 


Broom, 577 


Beta-eucaine, 523 


Brown mixture, 86, 647 


Beta-naphtol, 341 


Brown-Sequard's antineuralgic pills 


Betol, 342, 343 


Buchu, 656, 663 


Biniodide of mercury, 242 


Buckthorn, 81 


Birch tar, 649 


berries, 77 


Bismuth, 735 


Burgundy pitch, 784 


and ammonium citrate, 777 


-pitch plaster, 784 


chrysophanate, 778 


Burnt alum, 773 


citrate, 777 


Butter of antimony, 794 


naphtholate, 778 


Butternut, 705 


salicylate, 778 


Butyl-chloral hydrate, 446 


subcarbonate, 778 




subgallate, 778 


Cacao butter, 800 


subiodide, 778 


Cacodylates, 262 


subnitrate, 778 


Cactus, 580 


tribromphenate, 778 


Caffeina, 581 


Bismuthi et ammonii citras, 777 


citrate', 581 


benzoas, 355 


eftervescens, 581 


citras, 777 


Caffeine, 581 


salicylas, 778 


citrate, 581 


subcarbonas, 778 


Calabar bean, 536 


subiodidum, 778 


Calamus, 393 


subnitras, 778 


Calcii bromidum, 554 


Bitter wine of iron, 197 


carbonas pra-cipitatus, 167 


Bitters, 183 


hypophosphis, 217 


Black cohosh, 74 


phosphas pnvcipitatus, 218 


draught, 94 


sulphocarbolas, 328 


drop, 95 


Calcined magnesia, i<>o. 698 


haw, 84, 544 


Calcium bromide, 554 


mustard, 790 


hypophosphite, 217 


oxide of manganese, 21 1 


sulphocarbolate, 32S 



23 



8 5 2 



GENERAL INDEX. 



Calendula, 184 
Calomel, 241, 684 
m and jalap powder, 1 15 
Calumba, 184 
Calx, 797 

chlorata, 377 
Cambogia, 711 
Camphor, 400, 783 

ice, 134 

liniment, 401 

water, 401 
Camphora, 400 

carbolisata, 324 

monobromata, 401 
Camphorated carbolic acid, 324 

chloral, 435 

naphtol, 342, 433 

tincture of opium, 401, 453 
Camphoric acid, 401 
Canada liniment, 127 

pitch plaster, 137 

snake-root, 74 
Cannabine tannate, 47 1 
Cannabinone, 471 
Cannabis Indica, 471 
Cantharidal collodion, 786 

pitch plaster, 784 
Cantharides, 728, 785, 786 

cerate, 786 
Cantharidis paper, 137 
Cantharis, 786 
Capsicum, 385, 783 

plaster, 385 
Caraway, 384 

Carbasus acidi carbolici, 323 
Carbolated oil, 323 
Carbolic acid, 323 

gauze, 323 

plaster, 324 

water, 323 
Carbon tetrachloride, 432 
Cardamom, 391 
Cardamomum, 39 1 
Cardiac stimulants, 56 1 
Carniferrin, 205 
Carron oil, 127 
Carum, 384 
Caryophyllus, 388 
Casa bark, 663 
Cascara sagrada, S^, 692 
Cascarilla, 186 
Cassia cinnamon, 381 

fistula, 690 
Castor oil, 691 
Catarrh snuff, 1 15 
Catechol, 345 
Catechu, 735, 742 
Cathartic acid, 707 
Cathartics, 683 
Cathartinic acid, 707 
Caulophyllum, 728, 731 
Caustic potash, 796 

soda, 796 
Caustics (escharotics), 138, 793 



Cayenne pepper, 385 

Celery compound, 79 

Cerata, 133 

Cerate of lead subacetate, 751 

Cerates, 133 

Ceratum cantharidis, 786 

plumbi subacetatis, 751 
Cerii oxalas, 781 
Cerium oxalate, 735, 781 
Cerous oxalate, 781 
Cetraria, 800, 807 
Cevadilla, 607 
Ceylon cinnamon, 381 
Chalk mixture, 85 
Chalybeate pills, 122, 203 
Chamomile, 185 
Channing's solution, 67 
Chapman's dinner pill, 123 

mixture, 87 
Charcoal, 801 
Charta potassii nitratis, 615 

sinapis, 791 
Chemical food, 76 

waters, official, 64 
Chemistry, physical, relation of pharma- 
cology and therapeutics to, 840 
Chenopodium, 719, 720 
Chinconidinse sulphas, 223 
Chinoidine, 224 
Chinoidinum, 224 
Chinolin, 224 

tartras, 224 

tartrate, 224 
Chirata, 185 
Chloral, 434, 628 

ammonium, 435 

butylicum, 446 

formamide, 445 

formidatum, 445 

glycerite, 435 

menthol, 395 

phenol, 435 

urethane, 435, 444 
Chloralamide, 445 
Chloralose, 435, 444 
Chlor-ammonium, 444 
Chloretone, 436, 445 
Chloride of lime, 376 
Chlorinated lime, 376 
Chlorine water, 375 
Chlorodyne, 428 
Chloroform, 427, 783 

anodyne, 87 

emulsion, 427 

liniment, 427 

water, 427 
Chloroformum, 427 
Chlorohydrophosphate of lime, 74 
Cholera mixture, 87 
Chromic acid, 795 

anhydride, 795 

trioxide, 795 
Chrysotoxin, 501 
Churchill's iodine caustic, 68 



GENERAL INDEX. 



«53 



Churchill's tincture of iodine, 101' 
Cimicifuga, 74 
Cinchona, 221 

rubra, 222 
Cinchonidinae salicylas, 224 
Cinchonidine salicylate, 224 

sulphate, 223 
Cinchonina, 223 
Cinchoninse iodosulphas, 224 

sulphas, 223 
Cinchonine, 223 

iodosulphite, 348 

sulphate, 223 
Cinnamomum, 380 
Cinnamon, 380, 728 

water, 382 
Cinnamyl-eugenol, 389 
Citric acid, 159 
Citrine ointment, 244 
Citrophen, 417 
Clemen's solution, 68 
Climatotherapy, 24 
Cloves, 388 
Coca, 81, 513 
Cocaina, 514 

Cocainae hydrochloras, 514 
Cocaine, 514 

hydrochlorate, 514 

phenate, 514 
Cocainine, 523 

phenas, 514 
Cocapyrine, 523 
Cocculus, 498 

Indicus, 498 
Codeina, 454 
Codeine, 454 
Cod-liver' oil, 145, 728 
Coffee, 75 
Colchicum, 272 
Cold cream, 132 
Cole's dinner pill, 123 
Collargolum, 772 
Collodia, official, 130 
Collodion, 801 
Collodium cantharidatum, 786 

stypticum, 736 
Colloidal silver, 772 
Colocynth, 715 
Colocynthis, 715 
Colorless tincture of iodine, 10 1 
Col umbo, 184 

Comparative action of alkalies, 173 
Composition powder, 1 15 
Compound anise powder, 116 

cathartic pills, 711 

chalk powder, 167 

decoction of sarsaparilla, 280 

effervescing powder, 713 

extract of colocynth, 699, 715 

fluid extract of sarsaparilla, 280 
of stillingia, 281 

infusion of senna, 383, 694, 707 

iron mixture, 193, 358 

jalap powder, 716 



Compound liniment of mustai 
liquorice powder, 384 
mixture of glycyrrhiza, 647 
pills of antimony, 277 

of rhubarb, 700 
powder of glycyrrhiza, 647, 707 
of jalap, 164 
of morphine, 454 
of rhubarb, 392 
rhubarb pills, 702 

powder, 702 
solution of iodine, 263 
spirit of ether, 421 

of juniper, 383, 384, 666 
syrup of sarsaparilla, 280, 385 
of squill, 631, 651, 661 
of stillingia, 281 
tincture of benzoin, 353, 644, 700 
of cardamom, 381, 384, 391 
of catechu, 381 
of cinchona, 187, 223 
of gentian, 184 
of lavender, 381, 394 
Compressed pills, 126 
Confectio rosae, 749 

sennas, 383 
Confection of rose, 749 

of senna, 383, 707 
Confectiones, 117 
Confections, 117 
Coniina, 525 

Coniinae hydrobromas, 525 
Coniine, 525 

hydrobromate, 519 
Conium, 524 
juice, 525 
Conserve of rose, 118 
Convallamarin, 576 
Convallamarinum, 576 
Convallaria, 576 
Convallarin, 576 
Copaiba, 656, 671 
Copper, 735 

sulphate, 763 
Coriander, 382 
Coriandrum, 382 
Corn collodion, 131 
Corrosive chloride of mercury, 241 
mercuric chloride, 241 
sublimate, 241 
Cotarnine, 5 1 1 
Cotton-root bark, 507, 7 2 9 
Court plaster, 801, 810 
Coxe's hive syrup, 73 
Cramp bark, 545 
Crancsbill, 747 
Cream of tartar, 163 
Creasote, 329 
water, 330 
Creosotum, 329 
Cresol, 324 
Cresylic acid, 324 
Creta prseparata, 167 
Croton chloral, 460 



&54 



GENERAL INDEX. 



Croton collodion, 131 

oil, 708, 785 
Cubeb, 675 
Cubeba, 675 
Culver's root, 706 
Cupri arsenis, 254 

sulphas, 763 
Cupric arsenite, 254 
Curacoa aloes, 698 

cordial, 78 
Curare, 528 
Cusso, 719, 720, 725 
Cutol, 774 

Dalby's carminative, 86 
Damiana, 84 
Dandelion, 697 
Decocta, 95 
Decoction of cetraria, 807 

of stillingia, 281 
Decoctions, 95 
Decoctum cetrariae, 807 

sarsaparillse compositum, 280 

stillingise, 281 
Demulcents, 800 
Denarcotized opium, 453 
Deodorant solution, 69 
Deodorized alcohol, 586 

opium, 453 
Dermatol, 778 
Dermol, 778 
Dewees' carminative, 88 

tincture of guaiac, 101 
Di-acetyl morphine, 468 
Diachylon, 136 

ointment, 752 

plaster, 752 
Dialyzed iron, 203 
Diaphoretics, 618 
Diastase, 144 
Diet, 24 

Dietetic therapy, 24 
Diethylendiamine, 680 
Diethyl-sulphon-diethyl-methane, 448 
Diethyl-sulphon-methyl-ethyl-methane,448 
Digestants, 141 
Digitalein, 564 
Digitalin, 564 
Digitalinum, 564 
Digitalis, 563, 728 
Digitophyllin, 563 
Digitoxin, 564 
Diluted acetic acid, 159 

hydrobromic acid, 555 

hydrochloric acid, 150 

hydrocyanic acid, 545, 766 

hypophosphorous acid, 219 

nitric acid, 152 

nitrohydrochloric acid, 151, 152 

phosphoric acid, 15 1 

silver nitrate, 615, 767 

solution of lead subacetate, 751 

sulphuric acid, 151 
Dimethyl ether, 432 



Dinner pill, 122 
Disease, cause~s~of, 21 

healing of, 21 

medicines, 141 

treatment of, 23 
Dispensatory, 31 
Dispermine, 680 
Dithymol di-iodide, 349 
Diuretin, 581,656, 677 
Dobell's solution, 69, 324 
Donovan's solution, 65, 254 
Dover's powder, 114, 453 
Drastic purgatives, 715 
Dried alum, 773 

ferrous sulphate, 20 1 

sodium carbonate, 166 
Drugs, untoward effects of, 45 
Dry acid wines, 588 
Dysmenorrhea mixture, 100 

Ecbolics, 728 

Effervescent Carlsbad salt, 117 

citrated caffeine, 581 

Kissingen salt, 117 

magnesium citrate, 712 

potassium citrate, 164 

salts, 116 

Vichy salt, 1 17 
Effervescing saline water, 69 
Elaterin, 710 
Elaterinum, 710 
Electrotherapy, 25 
Electuar sennse, 118 
Elixir aurantiorum compositum, 96 

calisaya, 80 

of paraldehyde, 450 

of phosphorus, 213 

paraldehydi, 450 

phosphori, 213 

purgans, 83 
Elixiria, 77 
Elixirs, 77 

adjuvant, 78 

medicinal, 79 
Elm, 807 
Emetics, 625 
Emmenagogues, 728 
Emolients, 800 
Emplastra, 135 
Emplastrum acidi carbolici, 323 

ammoniaci cum hydrargyro, 241, 400 

arnicse, 613 

belladonnas, 477 

capsici, 385 

ferri, 202, 784 

hydrargyri, 241 

ichthyocollae, 801, 810 

opii, 453, 784 

picis Burgundicae, 784 • 
cantharidatum, 784, 786 

plumbi, 752 
Emulsion of ammoniac, 400 

of asafetida, 399 
Emulsions, 80 



GENERAL INDEX. 



855 



Emulsum ammoniaci, 400 

asafcetidae, 399 

chloroformi, 427 

guaiaci, 277 
Epinephrine, 235 
Epispastics, 785 
Epsom salt, 712 
Ergot, 501, 684, 728, 729 

of rye, 501 
Ergota, 501 
Ergotin, 502 

Erythrol tetra-nitrate, 553 
Erythrophleum, 656, 663 
Escharotics, 793 
Eserine salicylate, 536 

sulphate, 536 
Essence of ginger, 70 

of nutmeg, 388 

of peppermint, 394 

of spearmint, 396 

of wintergreen, 399 
Ether, 783 

Ethereal tinctures, 102 
Ethyl bromide, 431 

carbamate, 436 

chloride, 431 

iodide, 431 

methane, 436 
Ethylene bichloride, 431 

bromide, 431 

iodide, 432 
Ethyleneimine, 680 
Ethylidene chloride, 432 
Eucaine, 523 
Eucalyptol, 360 
Eucalyptus, 359 

water, 360 
Eudoxin, 779 
Eugenyl-acetamide, 389 
Euonymin, 704 
Euonymus, 704 
European hellebore, 607 
Europhen, 349 
Exalgine, 415 
Expectorants, 640 
Expressed oil of almond, 805 
Extract of aconite, 602 

of aloes, 699 

of arnica root, 613 

of cinchona, 222 

of colchicum root, 273 

of colocynth, 715 

of conium, 524 

of convallaria, 576 

of digitalis, 564 

of ergot, 501 

of euonymus, 704 

of gentian, 184 

of glycyrrhiza, 647 

of hematoxylon, 745 

of hyoscyamus, 487 

of iris, 705 

of jalap, 716 

of juglans, 706 



Extract of krameria, 744 
of leptandra, 706 
of nux vomica, 490 
of opium, 453 
of physostigma, 536 
of podophyllum, 718 
of pulsatilla, 612 
of quassia, 183 
of rhubarb, 702 
of taraxacum, 698 
of uva ursi, 665 
Extracta, 108 
fluida, 103 
Extractive preparations, 92 
Extracts, 108 

official, table of average doses, 109 
Extractum aconiti, 602 

fluidum, 602 
aloes, 699 
arnica; radicis, 613 

fluidum, 613 
aspidospermatis fluidum, 542 
belladonna; folio rum alcoholicum, 477 

radicis fluidum, 477 
cacti fluidum, 580 
calami fluidum, 393 
calendula; fluidum, 185 
calumba; fluidum, 184 
cannabis indica;, 471 

fluidum, 471 
capsici fluidum, 385 
chiratse fluidum, 185 
cinchona;, 222 

fluidum, 222 
cocas fluidum, 514 
cocculi fluidum, 499 
colchici radicis, 273 
fluidum, 273 

seminis fluidum, 273 
colocynthidis, 715 

compositum, 699, 715 
conii, 524 

fluidum, 525 
convallaria; fluidum, 576 
cubeba; fluidum, 675 
cusso fluidum, 725 
digitalis, 564 

fluidum, 564 
ergotse, 501 

fluidum, 502 
eucalypti fluidum, 360 
euonymi, 704 
gelsemii fluidum, 530 
gentiana;, 184 

fluidum, 184 
geranii fluidum, 747 
glycyrrhizse, 647 

fluidum, 647 

purum, 647 
gossypii radicis fluidum, 507 
grindelise fluidum, 534 
hamamelidis fluidum, 746 
hematoxyli, 745 
hydrastis fluidum, 508 



8 5 6 



GENERAL INDEX. 



Extractum hyoscyami, 487 
fluidum, 487 
ipecacuanhas fluidum, 634 
iridis, 705 

fluidum, 705 
jalapae, 716 
juglandis, 706 

juniperi fructus fluidum, 666 
krameriae, 744 

fluidum, 744 
leptandrge, 706 

fluidum, 706 
lobelige fluidum, 639 
lupulini fluidum, 469 
mezerei fluidum, 285 
nucis vomicae, 490 
fluidum, 490 

°pii, 453 

physostigmatis, 536 
phytolaccse radicis fluidum, 61: 
pilocarpi fluidum, 618 
podophylli, 718 

fluidum, 718 
pulsatillae, 612 
quassise, 183 

fluidum, 183 
rhei, 702 

fluidum, 702 
rhois aromaticae fluidum, 748 

glabrae fluidum, 748 
rosae fluidum, 749 
rubi fluidum, 750 
sabinae fluidum, 729 
sanguinariae fluidum, 282 
sarsaparillae fluidum, 280 

compositum, 280 
scillae fluidum, 661 
scoparii fluidum, 578 
senega? fluidum, 651 
sennae fluidum, 707 
serpentariae fluidum, 187 
spigeliae fluidum, 723 
stillingiae fluidum, 281 
compositum, 281 
stramonii seminis, 486 

fluidum, 486 
taraxaci, 698 

fluidum, 698 
uvae ursi, 665 

fluidum, 665 
Valeriana? fluidum, 402 
veratri viridis fluidum, 707 
viburni opuli fluidum, 545 

prunifolii fluidum, 544 
xanthoxyli fluidum, 286 
zingibens fluidum, 392 

False hellebore, 575 
Fats and oils, 145 
Fehling's solution, 67 
Fel bovis, 701 

purificatum, 701 
tauri, 701 
Fennel, 382 



Fennel water, 384 
Fenner's guaiac mixture, 100 
Feraldoid, 202 
Fercremol, 204 
Ferralbumose, 204 
Ferrated extract of apples, 101 
Ferratin, 203 
Ferri albuminas, 203 
arsenas, 203 

carbonas saccharatus, 193 
chloridum, 194 
citras, 195 

et ammonii citras, 1 96 
sulphas, 199 
tartras, 199 
et potassii tartras, 199 
et quininae citras, 196 

solubilis, 197 
et strychninae citras, 197, 491 
hypophosphis, 200 
iodidum saccharatum, 194 
lactas, 198 
oxidum hydratum, 1 98 

cum magnesia, 198 
phosphas solubilis, 199 
pyrophosphas solubilis, 200 
sulphas, 201 
exsiccatus, 201 
granulatus, 201 
valerianas, 200, 402 
Ferric ammonium sulphate, 199 
chloride, 194 
citrate, 195 
hydrate, 198 

with magnesia, 198 
hydroxide, 198 
hypophosphite, 200 
valerianate, 200, 402 
Ferropyrine, 205 
Ferrosol, 205 
Ferrostyptin, 205 
Ferrous lactate, 198 

sulphate, 201 
Ferruginous pills, 122, 203 
Ferrum caseinatum, 205 
dialysatum, 203 
reductum, 192 
Fersan, 205 
Figs, 800 
Fish berry, 498 
Flaxseed, 800 
Flour, 800 

Fluid extract of aconite, 602 
of arnica root, 613 
of aspidosperma, 542 
of belladonna root, 477 
of black haw, 544 
of cactus, 580 
of calamus, 393 
of calendula, 185 
of calumba, 184 
of capsicum, 385 
of chirata, 185 
of cinchona, 222 



GENERAL INDEX. 



«57 



Fluid extract of coca, 514 
of cocculus, 499 
of colchicum root, 273 

seed, 273 
of conium, 525 
of cotton-root bark, 507 
of cramp bark, 545 
of cubeb, 675 
of cusso, 725 
of digitalis, 564 
of ergot, 502 
of eucalyptus, 360 
of gelsemium, 530 
of gentian, 184 
of geranium, 747 
of ginger, 392 
of glycyrrhiza, 647 
of grindelia, 534 
of hamamelis, 746 
of hydrastis, 508 
of hyoscyamus, 487 
of Indian cannabis, 471 
of ipecacuanha, 634 
of iris, 705 

of juniper berries, 666 
of krameria, 744 
of leptandra, 706 
of lobelia, 639 
of lupulin, 469 
of mezereon, 285 
of nux vomica, 490 
of phytolacca root, 61 1 
of pilocarpus, 618 
of podophyllum, 718 
of quassia, 183 
of rhubarb, 702 
of rhus aromatica, 748 

glabra, 748 
of rose, 749 
of rubus, 750 
of sanguinaria, 282 
of sarsaparilla, 280 
of savin e, 729 
of scoparius, 578 
of senega, 651 
of senna, 707 
of serpentaria, 187 
of spigelia, 723 
of squill, 661 
of stillingia, 281 
of stramonium seed, 486 
of taraxacum, 698 
of uva ursi, 665 
of valerian, 402 
of veratrum viride, 607 
of xanthoxylum, 286 

Fluid extracts, 103 

Fluorescein, 345 

Fceniculum, 383 

Fomentations, 138 

Formamidate of mercury, 244 

Formic ether, 432 

Fowler's solution, 65, 253 

Foxglove, 563 



Francis's triplex pill, 125 
" French mixture," 67 
Friable pills, 126 

Gadberry's mixture, 88 
Galbanum plaster, 137 
Galla, 735, 740 
Gallal, 774 
Gallic acid, 735, 739 
Gamboge, 711 
Garlic, 641, 645 
Gastric sedatives, 627 
Gelatin, 800 
Gelsemina, 530 
Gelsemium, 530 
Gentian, 183 
Gentiana, 183 
Geranium, 735, 747 
Gin, 70, 587 
Ginger, 392 

Glacial acetic acid, 797 
Glauber's salt, 714 
Globules, 125 
Glucusimide, 681 
Gluside, 68 1 
Glycerine, 684, 800, 801 
Glycerinum, 801 
Glycerita, 84 
Glycerite of alum, 773 

of boroglycerin, 364 

of carbolic acid, 323 

of glyceryl borate, 364 

of hydrastis, 508 

of starch, 802 

of tannic acid, 736 

of tar, 649 

of yolk of egg, 802 
Glyceritum acidi carbolici, 323, 802 
tannici, 736, 802 

amyli, 802 

boroglycerini, 364, 802 

hydrastis, 508, 802 

picis liquidse, 649 

vitelli, 802 
Glycerole of pepsin, 85 
Glyconin, 802 
Glycyrrhiza, 646 

Glycyrrhizinum ammoniatum, 647 
Godfrey's cordial, 88 
Golden seal, 508 
Gossypii radicis cortex, 507 
Goulard's cerate, 134, 751 

extract, 751 
Granatum, 719, 720. 725 
Granulated ferrous sulphate, 201 
Granules, 125 

Green iodide of mercury, 242 
Griffith's mixture, 85, 198 
Grindelia, 533, 641 
Gross 1 antineuralgic pills, 123 
Guaiac, 277, 7 2 % 

emulsion, 277 
Guaiaci lignum, 276 

resina, 277 



8 5 8 



GENERAL INDEX. 



Guaiacol, 331 

benzoate, 332 

carbonate, 332 

di-iodide, 332 

salicylate, 332 
Guaiacoli benzoas, 332 

carbonas, 332 

di-iodidum, 332 

salicylas, 332 
Guaiacolum, 331 
Guaiacum wood, 276 
Guaranine, 581 
Gum Arabic, 806 

H^malbumin, 204 
Haemoferrum, 204 
Haemogallol, 203 
Haemoglobin, 204 
Haemol, 203 
Hall's dinner pill, 123 

solution of strychnine, 69 
Hamamelis, 735, 746 
Heavy magnesia, 169 
Hebra's ointment, 132 
Hedeoma, 728, 733 
Heliotherapy, 24 
Heliotropin, 387 
Hematics, 192, 728 
Hematoxylon, 735, 745 
Hemlock, 524 
Henbane, 487 
Heroine, 468 
Hiera picra, 115 
Hive syrup, 631 
Hoffman's anodyne, 71, 421 
Holocaine, 523 
Homatropina, 478 
Honey, 800 
Hope's mixture, 86 
Hops, 468 
Hot drops, IOI 
Humulus, 468 
Huxham's tincture, 99 
Hydragogue purgatives, 708 
Hydrargyri chloridum corrosivum, 241 
mite, 241 

cyanidum, 242 

formamidatum, 244 

iodidum fiavum, 242 
rubrum, 242 
viride, 242 

oxidum fiavum, 243 
rubrum, 243 

salicylas, 244 
. subsulphas flavus, 244 

tannas, 244 
Hydrargyrum, 239 

ammoniatum, 240 

cum creta, 167, 240 
Hydrastina, 508 
Hydrastinae hydrochloras, 508 
Hydrastine, 508 

hydrochlorate, 508 
Hydrastis, 508, 728, 729 



Hydrated oxide of iron, 198 
Hydrochloric acid, 150 
Hydrocyanic acid, 628 
Hydrogen peroxide, 64 
Hydronaphtol, 342, 344 
Hydroquinol, 344 
Hydroquinone, 344 
Hydrotherapy, 25 
Hyoscinae hydrobromas, 487 
Hyoscine hydrobromate, 487 
Hyoscyaminae hydrobromas, 488 
Hyoscyamine hydrobromate, 488 

sulphate, 488 
Hyoscyamus, 487, 684 
Hypnal, 435, 444 
Hypnosis in treatment of disease, 24 
Hypophosphite of iron, 75 

of lime, 74 
and soda, 74 

Iatrol, 350 
Ice, 627 

Iceland moss, 807 
Ichthyargon, 772 
Ichthyocolla, 809 
Ichthyol, 346 
Ichthyolum, 346 
Imidiod, 350 
Indian tobacco, 638 
Infusa, 94 
Infused oils, 1 30 
Infusion of cinchona, 222 

of convallaria, 576 

of digitalis, 564 

of hops, 469 

of juniper, 666 

of wild cherry, 187 
Infusions, 94 
Infusum cinchonae, 222 

convallariae, 576 

digitalis, 564 

humuli, 469 

juniperi, 666 

pruni Virginianae, 1 87 

sennae compositum, 383, 694, 707 
Iodi bromidum, 266 

chloridum, 266 
Iodide of calcium, 74 

of iron and manganese, 75 
Iodine, 263, 783, 785 

caustic, 68 

chloride, 266 

ointment, 263 

trichloride, 266 
Iodized carbolic acid, 324 

collodion, 13 1 
Iodo-casein, 350 
Iodocrol, 350 
Iodoform, 348 

collodion, 131 

and naphtalin powder, 1 15 
Iodoformal, 350 
lodoformogen, 350 
Iodoformum, 348 



GENERAL INDEX. 






Iodogallicin, 350 
Iodol, 349 
Iodoterpin, 350 
Iodothymoform, 350 
Iodothyrin, 233 
Iodum, 263 
Ipecac, 634, 785 
Ipecacuanha, 626, 634, 641 
Iridin, 705 
Iris, 704 
Irish moss, 75 
Iron, 728 

and ammonium citrate, 196 
tartrate, 199 

and potassium tartrate, 199 

and quinine citrate, 196 

and strychnine citrate, 197 

arsenate, 203 

by hydrogen, 192 

plaster, 202 

quinine chloride, 204 

solutions, 65 
Isinglass, 800, 810 

plaster, 809 
Itrol, 772 

Jaborandi, 82, 618 
Jaborine, 619 

Jackson's pectoral syrup, 76 
Jalap, 716 
Jalapa, 716 
James's powder, 1 14 
Jamestown weed, 485 
Janeway's pills, 123 
Javelle water, 68 
Jimson weed, 485 
Juglans, 705 
Juniper, 656, 665 

berries, 665 
•Juniperus, 665 

Kamala, 719, 720, 726 
Kinesotherapy, 24 
Kino, 735, 743 
Kosin, 725 
Koussein, 725 
Kousso, 725 
Krameria, 735, 743 

Labarraque's solution, 66, 376 
Lac sulphur, 695 
Lactic acid, 157 
Lactophenin, 417 
Lactophosphate of iron, 75 

of lime with iron, 75 
Lactucarium, 470 
Lady Webster's dinner pills, 122 
Lafayette mixture, 87 
Lamellae, 126 
Lard, 800 
Largin, 772 
Laudanum, 453 
Laughing gas, 433 
Laxative elixir, 83 



Laxatives, 690 
Lead, 735, 750 
acetate, 750 
carbonate, 751 
iodide, 266, 751 
nitrate, 752 
oxide, 752 
plaster, 752 
water, 66, 751 
Leeches, 728 
Leptandra, 706 
Leptandrin, 706 
Levant wormseed, 721 
Light magnesia, 169, 693 

red wines, 588 
Lignum vitae, 276 
Lily of the valley, 576 
Lime, 797 

juice and pepsin, 84 
liniment, 168 
water, 66, 168 
Liniment of lead subacetate, 751 
Linimenta, 127 
Liniments, 127 
Linimentum album, 128 
ammoniae, 599 
belladonnae, 477 
calcis, 168 
camphorae, 401 
chloroformi, 427 
plumbi subacetatis, 751 
saponis, 401 

sinapis compositum, 791 
Linseed meal, 800 

oil, 800, 806 
Liquid mixtures — internal, 85 

rennet, 69 
Liquor acidi arsenosi, 253 
ammonii acetatis, 622 
antimonii chloridi, 794 
arseni bromidi, 254 
arsenii bromidi, 68 • 
et auri bromidi, 254 
et hydrargyri iodidi, 243, 254 
calcis, 168 
ferri acetatis, 195 
chloridi, 195 
citratis, 196 
dialysatus, 203 

et ammonii acetatis, 195, 623 
nitratis, 202 
oxychlorati, 203 
peptonati, 203 
subsulphatis, 201 
tersulphatis, 202 
hydrargyri nitratis, 244 
, iodi compositus, 263 
magnesii citratis, 712 
mangano-ferri neptonatus, 203 
plumbi subacetatis, 751 

dilutus, 751 
potass < . 163 

arsenitis, 253 
potassii citratis, 164 



86o 



GENERAL INDEX. 



Liquor sodae, 165 
chloratse, 376 

sodii arsenatis, 254 

boratis compositus, 324 
carbolatus, 324 
Liquores, 64 

unofficial, 66 
Liquorice, 76, 641, 646, 800 

root, 646 
Litharge, 752 
Lithii benzoas, 354 

bromidum, 554 

carbonas, 168 

citras, 168 

effervescens, 169 

salicylas, 334 
Lithium benzoate, 354 

bromide, 554 

carbonate, 168 

citrate, 168 

salicylate, 334 
Lobelia, 626, 638 
Local anti-emetics, 627 
Logwood, 745 

Loomis's diarrhea mixture, 87 
Losophan, 349 
Lotio flava, 244 

nigra, 244 
Lotiones, 128 
Lugol's solution, 66 
Lunar caustic, 767 
Lupulin, 468 
Lupulinum, 468 
Lycopodium, 801, 810 
Lysol, 649 

Mace, 387 

Macis, 387 

Magendie's solution of morphine, 68 

Magnesia, 684, 693 

ponderosa, 169 
Magnesii carbonas, 169, 694 

citras effervescens, 712 

sulphas, 712 

sulphocarbolas, 328 
Magnesium carbonate, 169, 684, 694 

sulphate, 712 

sulphocarbolate, 328 
Malakin, 417 
Male fern, 723 
Mandrake, 478 
Manganese, 210 

dioxide, 21 1 

sulphate, 211 
Mangani dioxidum, 211 

sulphas, 211 
Manganum, 210 
Manna, 694 
Marigold, 184 
Marshmallow, 800, 808 
Mass of copaiba, 672 

of ferrous carbonate, 193 

of mercury, 240 
Massa copaibae, 672 



Massa ferri carbonatis, 193 

hydrargyri, 240 
Massse, 1 19 
Masses, 119 
Materia medica, 23 
May apple, .718 
Meadow-saffron, 272 
Medicated cottons, 139 

dressings, 139 

gauzes — carbasa, 139 

waters, 64 
Mentha piperita, 394 

viridis, 396 
Menthol, 395, 783 

benzoas, 355 
Mercurial ointment, 240 

plaster, 241 
Mercuric cyanide, 242 
Mercurous salicylate, 244 

tannate, 244 
Mercury, 239 

with chalk, 167, 240, 685 
Metallorum amarse, 125 
Methacetin, 416 
Methyl chloride, 432 
Methylacetanilide, 415 
Methylal, 432 
Methylen, 432 
Methylene bichloride. 432 
Methylic ether, 432 
Metric system, 55 
Mezereon, 284, 783, 785 
Mezereum, 284 
Mild chloride of mercury, 241 

mercurous chloride, 241 
Milk of sulphur, 695 
Mineral acids, 149 

astringents, 735, 750 

waters, 178 
Mistura antidysenterica, 86 

cretae, 168 

ferri composita, 193, 358 

glycyrrhizse composita, 647 

opii alkalinao, 88 

rhei et sodas, 166, 702 

solvens simplex, 86 
Misturae, 85, 
Mitigated caustic, 767 
Mixture of chloral and bromide, 86 

of rhubarb and soda, 166, 702 ■ 
Monobromated camphor, 401 
Monsel's solution, 65, 201 
Morphina, 453 
Morphinae acetas, 453 

hydrochloras, 454 

sulphas, 454 
Morphine, 684 

acetate, 453 

hydrochlorate, 454 

sulphate, 454 
Mother's salve, 133 
Motor excitants, 489 
Moulded silver nitrate, 767 
Mucilage of acacia, 806 



GENERAL INDEX. 



86 1 



Mucilage of elm, 808 

of sassafras pith, 809 

of tragacanth, 809 
Mucilages, 85 
Mucilagines, 85 
Mucilago acaciee, 806 

sassafras medulla, 809 

tragacanthae, 802, 809 

ulmi, 808 
Muriatic acid, 150 
Muscarine, 684 
Mustard, 728, 783, 790 

paper, 791 

volatile oil, 791 
Myristica, 387 
Myrrh, 357, 728 
Myrrha, 357 

Naphtalin, 341 

Naphtalinum, 341 

Naphtol, 341 

Naphtosalol, 342 

Native mineral springs, list of, 1 81 

Neutral mixture, 65 

Nitre, 615 

Nitric acid, 152 

Nitroglycerin, 549, 628 

pills, 124 
Nitrohydrochloric acid, 150, 152 
Nitrous oxide, 433 
Nuclein, 237 
Nutgall, 740 
Nutmeg, 387 
Nux vomica, 490, 684 

Oatmeal, 800 
Official — officinal, 31 
Oil of allspice, 390 

of American wormseed, 720 

of anise, 379 

of cade, 649 

of cajuput, 390, 783 

of caraway, 384 

of chenopodium, 720 

of cinnamon, 381 

of cloves, 389 

of copaiba, 672 

of coriander, 382 

of cubeb, 675 

of eucalyptus, 360 

of fennel, 383 

of flaxseed, 806 

of hedeoma, 733 

of juniper, 665 

of lavender flowers, 393 

of nutmeg, 387 

of pennyroyal, 733 

of peppermint, 394 

of pine, 648 

of rue, 729, 731 

of sandalwood, 674 

of savine, 729 

of Scotch fir, 641, 648 

of tar, 648 



Oil of turpentine, 783 

of wintergreen, 398 
Ointment of ammoniated mercury, 240 

of carbolic acid, 323 

of iodoform, 348 

of lead carbonate, 751 

of lead iodide, 752 

of mercuric nitrate, 244 

of potassium iodide, 264 

of red mercuric oxide, 243 

of sulphur iodide, 265 

of tannic acid, 736 

of yellow mercuric oxide, 243 

of zinc oxide, 759 
Oleatae, official, 129 

unofficial, 129 
Oleate of aconite, 603 

of sodium, 69 

of veratrine, 607 
Oleates, 129 
Oleatum aconitinae, 603 

veratrinae, 607 
Oleoresin of aspidium, 724 

of capsicum, 385 

of cubeb, 675 

of ginger, 392 

of lupulin, 469 

of pepper, 387 
Oleoresina aspidii, 724 

capsici, 385 

cubebae, 675 

lupulini, 469 

piperis, 387 

zingiberis, 392 
Oleoresina, no 
Oleoresins, no 
Oleum acidi carbolici, 323 

amygdalae expressum, 805 

anisi, 379 

cadinum, 649 

cajuputi, 390 

cari, 384 

caryophylli, 389 

chenopodii, 720 

cinnamom i, 381 

copaibae, 672 

coriandri, 382 

cubebae, 675 

eucalypti, 360 

foeniculi, ^8^ 

gaultheriae, 398 

hedeomae, 733 

juniperi, 665 

lavandukv tlorum, 393 

lini, 806 

rnenthae piperita, 394 

morrhuae, 145 

myristicse, 387 

olivse, 804 

phosphoratum, 21 ; 

picis liquidse, I 

pimentse, 300 

pini sylvestris, 041. (>4s 

ricini. 69 1 



862 



GENERAL INDEX. 



Oleum rusci, 649 

rutse, 731 

sabinae, 729 

santali, 674 

sinapis volatile, 791 

templinum, 648 

tiglii, 708 
Olive oil, 800, 804 
Onion, 641, 645 
Opii pulvis, 453 
Opium, 452, 628 

compared with its alkaloids, 466 

deodoratum, 453 

plaster, 453 
Opodeldoc, 128 
Organic acids, 157 
Organotherapy, 231 
Orphal, 779 
Orthodioxybenzene, 345 
Orthoform, 523 
Osmic acid, 154 
Ouabain, 573 
Oxgall, 701 

Oxysulphate of iron, 67 
Oxytocics, 728 

Pancreas extracts, 238 
Pancreatic solution, 68 
Pancreatin, 143 
Pancreatinum, 143 
Papain, 143 
Papers, 137 
Paradioxybenzene, 344 
Paraffin, 800 
Paraldehyde, 450 
Paraldehydum, 450 
Paregoric, 99, 453 
Parrish's camphor mixture, 86 
Parsley, 732 
Parvules, 125 
Pearson's solution, 254 
Pelletierinse tannas, 726 
Pelletierine, 726 

tannate, 726 
Pennyroyal, 733 
Pental, 433 
Pepo, 719, 720, 727 
Pepper, 387 
Peppermint, 394 
Pepsin, 141 
Pepsinum, 141 / 

saccharatum, 1 42 
Peptonizing powder, 115 
Peronine, 468 
Petrolatum, 800 
Petroleum, 800 
Petroselinum, 732 
Pharmaceutical preparations, 62 
Pharmacognosy, 23 
Pharmacology, 21 

and therapeutics, relation of physical 
chemistry to, 840 
Pharmacopoeia, 31 
Pharmacotherapy, 26 



Pharmacy, 23 
Pheasant's eye, 575 
Phenacetin, 413 
Phenocoll, 414 
Phenol-camphor, 324 

iodatum, 324 

-sodique, 97, 324 
Phenyl salicylate, 339 
Phesin, 417 

Phosphatic emulsion, 92 
Phosphorated oil, 213 
Phosphoric acid, 15 1 
Phosphorus, 212 

Physical chemistry, relation of pharma- 
cology and therapeutics to, 840 
Physicomechanical therapy, 24 ' 
Physostigma, 536, 684 
Physostigminse hydrobromas, 537 

salicylas, 536 

sulphas, 536 
Physostigmine hydrobromate, 537 

salicylate, 536 

sulphate, 536 
Phytolacca fruit, 610 

root, 610 
Phytolacca? fructus, 610 

radix, 610 
Picrotoxin, 499 
Picrotoxinum, 499 
Pills, 120 

of aloes, 699 

and asafetida, 399, 699 
and iron, 202, 699 
and mastich, 699 
and myrrh, 358, 699 

of asafetida, 399 

of ferrous carbonate, 203 

of ferrous iodide, 194 

of opium, 453 

of phosphorus, 213 

of rhubarb, 702 
Pilocarpidine, 618 
Pilocarpine hydrochloras, 618 
Pilocarpine, 618, 684, 729 

hydrochlorate, 618 
Pilocarpus, 618, 641 
Pilulae, 120 

aloes, 699 

et asafcetidse, 399, 699 
et ferri, 202, 699 
et mastiches, 699 
et myrrhae, 358, 699 

antimonii compositse, 277 

asafcetidae, 399 

catharticae compositse, 711, 715, 716 
vegetabiles, 706, 715, 716 

Cochia, 124 

ferri carbonatis, 203 

et quininas compositas, 125 
iodidi, 194 

hydrargyri, 240, 685 

official, 120 

oph, 453 

phosphori, 213, 802 



GENERAL INDEX. 



863 



Pilulae, rhei, 702 

composite, 700, 702 

unofficial, 122 
Pimenta, 390 
Pinkroot, 723 
Piper, 387 
Piperazidine, 680 
Piperazinum, 680 
Piperin, 387 
Piperinum, 387 
Piperonal, 387 
Pitch, 783 
Pituitary body, 237 
Pix betulae, 649 

Burgundica, 784 

liquida, 648 
Pixol, 649 
Plaster-mull, 138 
Plaster-of-Paris bandages, 140 
Plasters, 135 
Plumbi acetas, 750 

carbonas, 751 

iodidum, 266, 751 

nitras, 752 

oxidum, 752 
Plumbum, 750 
Plummer's pills, 122, 127 
Podophyllotoxin, 718 
Podophyllum, 718 
Poison ivy, 511 
Poke root, 610 
Pomegranate, 725 
Port wine, 588 
Porter, 588 
Potassa, 796 

cum calce, 796 

with lime, 796 
Potassii acetas, 163 

bicarbonas, 163 

bichromas, 368 

bitartras, 163 

bromidum, 553 

carbonas, 164 

chloras, 369 

citras, 164 

effervescens, 164 

cyanidum, 549 

et sodii tartras, 713 

hypophosphis, 218 

iodidum, 264 

nitras, 615 

permanganas, 366 

sulphas, 712 

sulphocarbolas, 328 

tartras, 165 
Potassio-ferric tartrate, 199 
Potassium acetate, 163 

and sodium tartrate, 713 

bicarbonate, 163 

bichromate, 368 

bitartrate, 163, 685 

bromide, 553 

carbonate, 164 

chlorate, 369 



Potassium citrate, 164 

cyanide, 549 

hydrate, 796 

hydroxide, 796 

hypophosphite, 218 

iodide, 264, 641 

nitrate, 615 
paper, 615 

permanganate, 366, 729 

sulphate, 712 

sulphccarbolate, 328 

tartrate, 165, 685 
Poultice (cataplasm), 138 
Powder of ipecac and opium, 453, 635 
Powdered opium, 453 
Powders, 113 

unofficial, 114 
Precipitated calcium carbonate, 167 
phosphate, 218 

sulphur, 695 

zinc carbonate, 759 
Preparations for external use, 1 26 
of ammonium, 170 
of calcium, 167 
of iron, 192 
of lithium, 168 
of magnesium, 169 
of sodium, 165 
Prepared chalk, 167 
Prescription-writing, 825 
Prescriptions, 811 
Prickly ash, 286 
Proof spirit, 587 
Protargol, 772 
Protective agents, 800 
Protiodide of mercury, 242 
Prunus Virginiana, 186 
Prussic acid, 545, 766 
Pulsatilla, 612 
Pulveres, 113 
Pulvis aromaticus, 381, 391 

cretae aromaticus, 167 
cum opio, 167 
compositus, 167 

digestivus, 115 

effervescens compositus, 7 1 3 

glycyrrhizre compositus, 384, 647, 707 

ipecacuanha? et opii, 453, 635 

jalapre compositus, 164, 716 

morphinse compositus, 454 

rhei compositus, 392, 702 
Pumpkin seed, 727 
Purging cassia, 690 
Purified aloes, 699 

cotton, 801 

oxgall, 701 
Pyrocatechin, 345 

Quassia. 183 
Quebrachine, 542 
Quebracho, 641 
Queen's root, 2S1 
Quercus alba. 735, 741 
Quevenne's iron, 192 



864 



GENERAL INDEX. 



Quicksilver, 239 
Quinetum, 224 
Quinidinge sulphas, 223 
Quinidine sulphate, 223 
Quininse bisulphas, 223 

hydrobromas, 223 

hydrochloras, 223 
carbamidata, 224 

sulphas, 223 

valerianas, 224 
Quinine, 223, 728, 729 

bisulphate, 223 

hydrobromate, 223 

hydrochlorate, 223 

valerianate, 224 
Quinolin, 224 

Rectified spirit, 587 
Red cinchona, 222 

iodide of mercury, 242 

mercuric iodide, 242 

precipitate, 243 

rose, 749 

wine, 587 
Reduced iron, 192 
Remedies, 21 

administration of, 37 
dosage in, 42 
Resin of copaiba, 672 

of jalap, 716 

of podophyllum, 718 

of scammony, 717 
Resina copaibse, 672 

jalapse, 716 

podophylli, 718 

scammonii, 717 
Resinae, ill 
Resins, in 
Resopyrine, 345 
Resorcin, 344 
Resorcinum, 344 
Restoratives, 141 
Rhamnus Purshiana, 692 
Rhatany, 743 
Rheum, 701 
Rhubarb, 701 
Rhus aromatica, 748 

glabra, 735, 748 

toxicodendron, 511, 785 
Rochelle salt, 713 
Rosa gallica, 735, 749 
Rottlera, 726 
Rotulse, 126 
Rubefacients, 783 
Rubus, 735, 749 
Rue, 728, 730 
Rum, 587 
Ruta, 730 

Sabina, 729 

Saccharated ferrous carbonate, 193 

iodide, 194 
Saccharin, 681 
Saccharine substances, 641 



Saccharinum, 681 

Salacetol, 340 

Sales effervescentes, 116 

Salicin, 340 

Salicinum, 340 

Salicylamid, 340 

Salicylated powder of talcum, II 1 

Salicylphenetidin, 417 

Salifebrin, 340 

Saligenin, 340 

Salinaphtol, 342 

Saliphenin, 417 

Salipyrine, 340 

Salocoll, 417 

Salol, 339 

Salophen, 340 

Saltpetre, 615 

Salumin, 774 

Sanguinal, 205 

Sanguinaria, 282 

Sanguinarine nitrate, 282 

Sanguiniform, 205 

Santonica, 719, 721 

Santonin, 721 

Santoninum, 721 

Saponin, 641 

Sarsaparilla, 279 

Sassafras medulla, 809 

pith, 800, 809 
Savine, 728, 729 
Scammonium, 717 
Scammony, 717 
Scilla, 660 
Scoparine, 578 
Scoparius, 577 
Scopolia carniolica, 478 

Japonica, 458 
Sebadilla, 607 
Seidlitz powder, 114, 713 
Senega, 641, 651 
Senna, 706 

aromatic, 77 

compound, 77 
Serpentaria, 187 
Serum-therapy, 285 
Sherry wine, 588 
Silver, 735 

colloidal, 772 

cyanide, 766 

iodide, 266, 766 

nitrate, 767, 785 

oxide, 767 
Simple bitters, 183 

cerate, 133 

purgatives, 698 
Sinapis alba, 790 

nigra, 790 
Skin medication, methods of, 37 
Slippery elm, 800, 807 
Smith's solution of bromine, 66 
Soap liniment, 401, 800 
Socotrine aloes, 699 
Soda, 796 

mint, 88 



GENERAL INDEX. 



S6 5 



Sodii acetas, 165 
arsenas, 254 
benzoas, 354 
bicarbonas, 165 
bisulphis, 374 
boras, 363 
bromidum, 553 
carbonas, 166 

exsiccatus, 166 
hypophosphis, 218 
hyposulphis, 374 
iodidum, 264 
nitras, 617 
nitris, 551 
phosphas, 713 
salicylas, 334 
sulphas, 714 
sulphis, 374 
sulphocarbolas, 328 
Sodio-salicylate of theobromine, 677 
Sodio-theobromine salicylate, 581 
Sodium acetate, 165 
arsenate, 254 
benzoate, 354 
bicarbonate, 165 
bisulphite, 374 
borate, 363 
bromide, 553 
carbonate, 166 
hydrate, 796 
hydroxide, 796 
hypophosphite, 218 
hyposulphite, 374 
iodide, 264 
nitrate, 617 
nitrite, 551 
orthophosphate, 713 
phosphate, 713 
salicylate, 334 
sulphate, 714 
sulphite, 374 
sulphocarbolate, 328 
Solid mixtures, internal use, 112 

opodeldoc, 128 
Soluble feme phosphate, 199 

pyrophosphate, 200 
iron and quinine^ citrate, 197 
saccharated iron," 76 
Solution of ammonium acetate, 622 
of antimony chloride, 794 
of arsenic and gold bromide, 254 
and mercuric iodide, 243, 254 

bromide, 254 
of arsenous acid, 253 
of basic ferric sulphate, 201 
of boroglyceride, 364 
of calcium hydrate, 168 
of chlorinated soda, 376 

potassa, 68 
of ferric acetate, 195 

chloride, 195 

citrate, 196 

nitrate, 202 

subsulphate, 201 

55 



Solution of ferric sulphate, 202 

of ferrous chloride, 67 

of hydrogen dioxide, 371 

of iodide of mercury and potassium, 67 

of iron and ammonium acetate, 195, 623 

of lead subacetate, 751 

of lime, 168 

of magnesium citrate, 712 

of mercuric nitrate, 244 

of oxysulphuret of calcium, 66 

of peptonate of iron, 203 
and manganese, 203 

of potash, 163 

of potassium arsenite, 253 

of saccharin, 68 

of soda, 165 

of sodium arsenate, 254 
hydrate, 165 
silicate, 80 1 
Solutions, 64 

of metallic compounds, 66 
Sozal, 775 
Sozoiodol, 349 
Spanish flies, 786 
Sparkling wines, 588 
Sparteinse sulphas, 578 
Sparteine sulphate, 578 
Spearmint, 396 

water, 396 
Spermaceti, 800 
Sphacelotoxin, 501 
Spice plaster, 137 
Spigelia, 719, 720, 723 
Spinal analgesia, 522 
Spirit of ammonia, 598 

of anise, 380 

of camphor, 401 

of chloroform, 427 

of cinnamon, 382 

of ether, 421 

of gaultheria, 398 

of glonoin, 551 

of juniper, 666 

of lavender, 394 

of nitroglycerin, 551 

of nitrous ether, 624 

of nutmeg, 388 

of peppermint, 394 

of phosphorus, 213 

of soap, 71 

of spearmint, 396 
Spirits, 70 

Spiritus setheris, 421 
compositus, 421 
nitrosi, 624 

ammonia?, 598 

aromaticus, 170, 599 

anisi, 380 

aurantii compositus, 380 

camphoroe, 401 

chloroformi, 427 

cinnamomi, 382 

frumenti, 587 

gaultheria;, 398 



866 



GENERAL INDEX. 



Spiritus glonoini, 551 
juniperi, 666 

compositus, 385, 666 
lavandulse, 394 
menthae piperita?, 395 
viridis, 396 
• Mindererus, 65 
myristicae, 388 
phosphori, 213 
rectificatus, 587 
vini gallici, 586 
Spleen-mixture, 88 
Spongiopiline, 138 
Squibb's diarrhea mixture, 87 
podophyllum pills, 1 25 
rhubarb mixture, 88 
Squill, 656, 660 
Starch, 800 
Stillingia, 281 

compositus, 107 
St. John Long's liniment, 128 
Stake's expectorant, 88 

liniment, 128 
Stramonii folia, 485 

semen, 486 
Stramonium, 685 

leaves, 485 

seed, 486 
Strengthening plaster, 136, 202 
Stronger ammonia water, 598 
Strontii bromidum, 555 

iodidum, 265 
Strontium bromide, 555 

iodide, 265 
Strophanthin, 573 
Strophanthus, 573 
Strychnine, 490, 684, 728 
Styptic collodion, 736 
Sublimed sulphur, 695 
Succus conii, 525 
Sugar of lead, 750 
Suggestion therapy, 24 
Sulphaminol, 349 
Sulphonal, 447 
Sulphur acid, 373 

iodide, 265 

lotum, 695 

•ointment, 695 

prsecipitatum, 695 

sublimatum, 695 
Sulphuric acid, 151 
Sulphuris iodidum, 265 
Sumach, 748 
Sumbul, 543 
Sun mixture, 87 
Suppositoria, 1 34 

glycerini, 802 
Suppositories, 134 

of glycerin, 802 
Suprarenal gland, 235 
Sweet flag, 393 

spirit of nitre, 71, 624 

sumach, 748 

tincture of rhubarb, IOO, 702 



Sweet wines, 588 
Syrup of acacia, 807 
of althaea, 808 

of calcium lactophosphate, 158 
of citric acid, 159 
of Dover's powder, 76 
of ferrous iodide, 194 
of garlic, 645 
of ginger, 392 
of hydriodic acid, 263 
of hypophosphites, 219 
with iron, 198, 219 
of ipecac, 635 
of lactucarium, 470 
of lime, 168 
of morphine, 76 
of phosphates of iron, quinine, and 

strychnine, 198 
of rhubarb, 702 
of senega, 651 
of senna, 707 
of squill, 661 
of tar, 648 
of tolu, 644 
of wild cherry, 187 
Syrups, 71 
Syrupus acacia?, 807 
acidi citrici, 159 

hydriodici, 263 
allii, 645 
althaeae, 808 

calcii lactophosphatis, 158 
calcis, 168 
corrigens, 75 
ferri iodidi, 194 

quininae et strychninae phosphatum, 
198, 491 
hypophosphitum, 219 

cum ferro, 198, 219 
ipecacuanhas, 635 
krameriae, 744 
lactucarii, 470 
picis liquidae, 648 
pruni Virginianae, 187 
rhei, 702 

aromaticus, 703 
sarsaparillae compositus, 280, 380 
scillse, 661 

compositus, 631, 651, 661 
senegae, 651 
sennae, 707 

stillingiae compositus, 281 
tolutanus, 644 
zingiberis, 392 
Systemic anti-emetics, 628 

Taka-diastase, 145 
Tanacetum, 732 
Tannal, 774 
Tannalbin, 738 
Tannic acid, 735 
Tannigen, 738 
Tannocol, 738 
Tannoform, 738 



GENERAL INDEX. 



867 



Tannon, 738 
Tannopin, 738 
Tansy, 728, 732 
Tar, 85, 641 

alkaline, 68 

compound ointment, 133 

mixture, 88 

ointment, 648 

water, 648 
Taraxacum, 697 
Tartar emetic, 630, 785 
Tartaric acid, 160 
Tartrated antimony, 630 
Tasteless syrup of iodide of iron, 75 

tincture of iron, 10 1 
Terebene, 641, 653 
Terebenum, 653 
Terpin hydrate, 641, 654 
Terpini hydras, 654 
Terpinol, 654 
Testicular juice, 232 
Tetrachlormethane, 432 
Tetronal, 448 
Theine, 581 
Theobromine, 581 
Therapeutics, 23 

and pharmacology, relation of physical 
chemistry to, 840 
Therapy, dietetic, 24 

physicomechanical, 24 

suggestion, 24 
Thieimann's mixture, 87 
Thioform, 778 
Thiol, 347 
Thiolum, 347 
Thioresorcin, 345 

Thompson's solution of phosphorus, 68 
Thorn apple, 485 
Thymacetin, 396 
Thymol, 396 
Thymus gland, 237 
Thyroid extract, 233 
Tinctura aconiti, 602 

aloes, 700 

et myrrhas, 358, 700 

arnicas florum, 613 
radicis, 614 

asafcetidas, 399 

belladonnas foliorum, 477 

benzoini, 353 

composita, 353, 644, 700 

cacti, 580 

calendulas, 184 

calumbas, 185 

cannabis indicae, 471 

cantharidis, 786 

capsici, 385 

cardamomi, 391 

composita, 381, 384, 391 

catechu composita, 381, 742 

chiratas, 185 

cinchonas, 222 

composita, 187, 223 

cmnamomi, 381 



Tinctura cocculi, 499 
colchici seminis, 273 
conii, 524 
cubebas, 675 
digitalis, 564 
ergotas, 502 
eucalypti, 360 
ferri acetatis, 203 

chloridi, 195 
gallas, 740 

gentianae composita, 184 
guaiaci, 277 

ammoniata, 277 
humuli, 469 
hydrastis, 508 
hyoscyami, 487 
iodi, 263 

ipecacuanhas et opii, 453, 635 
kino, 743 
krameriae, 744 
lactucarii, 470 

lavandulae composita, 381, 394 
lobelias, 639 
nucis vomicae, 490 

opii, 453 

camphorata, 380, 401, 453 

deodorati, 453 
physostigmatis, 536 
Pulsatillas, 612 
quassias, 183 
rhei, 702 

aromatica, 702 

dulcis, 702 
rhois toxicodendri, 512 
sanguinarias, 282 
scillas, 661 
serpentarias, 187 
stillingias, 281 
stramonii seminis, 486 
strophanthi, 573 
sumbul, 543 
tolutana, 644 
Valerianae, 402 

ammoniata, 402 
veratri viridis, 607 
zingiberis, 392 
Tincture of aconite, 602 
of aloes, 700 

and myrrh, 358, 700 
of arnica flowers, 613 

root, 614 
of asafetida, 399 
of belladonna leaves, 477 
of benzoin, 353 
of cactus, 580 
of calendula, 185 
of calumba, 1S4 
of cantharides, 786 
of capsicum, 385 
of cardamom, 391 
of chirata, 1S5 
of cinchona, 222 
of cinnamon, 381 
of cocculus, 499 



868 



GENERAL INDEX. 



Tincture of colqhicum seed, 273 

of conium, 525 * 

of cubeb, 675 

of cudbear, 102 

of deodorized opium, 453 

of digitalis, 564 

of Dover's powder, 453 

of ergot, 502 

of eucalyptus, 360 

of ferric acetate, 203 
chloride, 195 

of ginger, 392 

of guaiac, 277 

of hops, 469 

of hydrastis, 508 

of hyoscyamus, 487 

of Indian cannabis, 471 

of iodine, 263 

of ipecac and opium, 453, 635 

of kino, 743 

of krameria, 744 

of lactucarium, 470 

of lobelia, 639 

of lupulin, 469 

of nutgall, 740 

of opium, 453 

of phosphorus, 213 

of physostigma, 536 

of poppy, 102 

of pulsatilla, 612 

of quassia, 183 

of rhubarb, 702 

of rhus toxicodendron, 512 

of serpentaria, 187 

of squill, 661 

of stillingia, 281 

of stramonium seed, 486 

of strophanthus, 573 

of sumbul, 543 

of tolu, 644 

of toxicodendron, 512 

of valerian, 402 

of veratrum viride, 607 
Tinctures, 97 
Tolu, soluble, 103 
Topical remedies, 783 
Toxicology, 26 
Tragacanth, 800, 808 
Tragacantha, 808 
Trional, 448 
Triplex pills, 125 
Trituratio elaterini, 710 
Trituration of elaterin, 710 
Troches, 118 

of ammonium chloride, 642 

of catechu, 742 

of chalk, 167 

of cubeb, 675 

of ginger, 392 

of ipecac, 635 

of iron, 202 

of krameria, 744 

of liquorice and opium, 453 

of morphine and ipecac, 454, 635 



Troches of peppermint, 395 

of potassium chlorate, 369 

of santonin, 721 

of sodium bicarbonate, 166 

of tannic acid, 736 
Trochisci acidi tannici, 736 

ammonii chloridi, 642 

catechu, 742 

cretae, 167 

ferri, 202 

glycyrrhizae et opii, 380, 453 

ipecacuanhae, 635 

krameriae, 744 

menthae piperitae, 395 

morphinae et ipecacuanhae, 454, 635 

potassii chloratis, 369 

santonini, 721 

sodii bicarbonatis, 166 

zingiberis, 392 
Tropacocaine, 523 
Tulley's powder, 114 
Tumenol, 347 
Tumenolum, 347 
Turlington's balsam, 98 
Turner's cerate, 133 
Turpentine, 656 
Turpeth mineral, 244 

Ulmus, 807 
Unguenta, 13 1 

Unguentum acidi carbolici, 323 
tannici, 736 
belladonnae, 477 
camphoratum, 133 
diachylon, 752 
hydrargyri, 240 
ammoniati, 240 
nitratis, 244 
oxidi flavi, 243 
rubri, 243 
iodi, 263 
iodoform i, 348 
matris, 133 
picis liquidae, 648 
plumbi carbonatis, 751 

iodidi, 752 
potassii iodidi, 264 
stramonii, 486 
sulphuris, 695 
iodidi, 265 
veratrinae, 607 
zinci carbonatis impuri, 133 
oxidi, 759 
Ural, 435, 444 
Uralium, 435 
Urea, 656 

Urethane, 436, 444 
Ustilago, 729 
Uva ursi, 656, 664 

Valerian, 401 
Valeriana, 401 
Vallet's mass, 1 19, 193 
Vaseline, 800 






GENERAL INDEX. 



869 



Vegetable astringents, 735 
Velpeau's diarrhea mixture, 87 
Veratrina, 607 
Veratrine, 607 

ointment, 607 
Veratrum album, 607 

viride, 606 
Vermicides, 719 
Vermifuges, 719 
Vesicants, 785 
Viburnum opulus, 545 

prunifolium, 544 
Vienna caustic, 796 

paste, 796 
Villate's solution, 86 
Vina, 95 
Vinegar of opium, 453 

of sanguinaria, 252 

of squill, 661 
Vinegars, 95 
Vinum album, 587 

antimonii, 63 1 

colchici radicis, 273 
seminis, 273 

ergotae, 502 

ferri amarum, 197 
citratis, 196 

ipecacuanha?, 635 

opii, 453 

pic is, 649 

rubrum, 587 
Virginia snake root, 187 
Vleminck's solution or lotion, 66 
Volatile oil of mustard, 791 

oils, 783 

Wahoo, 81, 704 
Warburg's pills, 124 

tincture, 100, 101 
Warming plaster, 136, 784: 
Washed sulphur, 695 
Washes, 128 

Weights and measures, 54 
Whiskey, 70, 587 
White arsenic, 252 

ash, 97 

hellebore, 607 

lead, 751 

mustard, 790 

oak, 741 

of egg, 800 



White pine compound, 77 

wine, 587 
Wild cherry, 97, 186 

ferrate d, 97 
Wilkinson's ointment, 133 
Wine of antimony, 631 

of colchicum root, 273 
seed, 273 

of ergot, 502 

of ferric citrate, 196 

of ipecac, 635 

of opium, 453 

of tar, 649 
Wines, 95 
Woorari, 528 

Xanthoxylum, 286 
Xeroform, 779 

Yellow iodide of mercury, 242 

jasmine, 530 

mercuric oxide, 243 
subsulphate, 244 

mercurous iodide, 242 

wash, 244 
Verba santa, 75 

Zedoary compositus, 93 
Zinc, 735, 758 

acetate, 759 

bromide, 554 

chloride, 798 

iodide, 265, 759 

oxide, 759 

phosphide, 219 

sulphate, 759 

sulphocarbolate, 328 

valerianate, 402 
Zinci acetas, 759 

bromidum, 554 

carbonas praecipitatus, 759 

chloridum, 798 

iodidum, 265, 759 

oxidum, 759 

phosphidum, 219 

sulphas, 759 

sulphocarbolas, 328 

valerianas, 402 
Zincum, 758 
Zingiber, 70, 392 



CLINICAL INDEX 



Abrasions — 

Isinglass, 810 

Potassium nitrate, 616 

Protectives, 801 
Abscess — 

Calcium phosphate, 220 

Cocaine, 521 

Cod liver oil, 148 

Naphtalin, 343 

Onion poultice, 646 

Phytolacca, 61 1 

Solution of ammonium acetate, 623 
Acidity of Stomach — 

Alkalies, 175 

Ammonium preparations, 601 
Acne — 

Fowler's solution, 259 

Hydrastine ointment, 510 

Ichthyol, 347 

Phosphorus, 217 

Pyrogallic acid, 739 

Quinine, 230 

Salicylic acid, 337 

Sulphur, 696 
Acne Rosacea — 

Bismuth subnitrate, 780 

Ergot, 506 

Hamamelis, 746 

Ichthyol, 347 

Resorcin, 345 
Aconite-poisoning — 

Atropine, 485 

Digitalis, 571 
Addison's Disease — 

Suprarenal extract, 237 
Adenitis — 

Camphorated naphtol, 343 

Colloidal silver, 772 

Naphtalin, 343 

Pilocarpine, 621 

Potassium iodide, 27 1 
After-pains — 

Black haw, 544 

Camphor, 407 
Albuminuria — 

Arsenic, 261 
Alcoholic Tremor — 

Cocaine, 522 
Alcoholism- 
Aromatic spirit of ammonia, 601 
870 



Alcoholism — 

Cocaine, 522 

Coffee, 585 

Solution of ammonium acetate, 623 

Strychnine, 497 

Tincture of lupulin, 470 

Zinc oxide, 762 
Alopecia — 

Aqua ammonise, 601 

Capsicum, 386 

Nutgall ointment, 740 

Pilocarpine, 621 

Quinine, 229 

Savine, 730 

Tannic acid, 737 

Tincture of cantharides, 789 

Turpentine, 669 
Amaurosis — 

Strychnine, 497 
Amblyopia — 

Pilocarpine, 621 
Amenorrhea — 

Aloes, 700 

Ammonium chloride, 643 

Apioline, 733 

Ergot, 505 

Guaiac, 279 

Iron, 209 

Manganese salts, 212 

Quinine, 230 

Sanguinaria, 284 

Savine, 730 

Senega, 652 

Tansy, 732 

Tincture of cantharides, 789 
Anal Fissure — 

Belladonna ointment, 484 

Bismuth subnitrate, 780 

Chloral, 441 

Cocaine, 521 

Fluid extract of hydrastis, 510 

Geranium, 747 

Glycerin, 803 

Iodoform, 352 

Krameria, 744 

Red rose, 749 

Sulphur, 697 

Tannic acid, 737 

Tincture of iodine, 270 

White oak, 741 



CLINICAL INDEX. 



871 



Anal Fissure — 

Zinc oxide, 761 
Anemia — 

Arsenic, 259 

Bone marrow, 238 

Cod liver oil, 148 

Copper, 765 

Digitalis, 570 

Hypophosphites, 220 

Iron, 205 

Manganese, 212 

Nuclein, 238 

Phosphoric acid, 156 

Potassium chlorate, 37 

Potassium permanganate, 367 

Red wine, 597 

Strychnine, 496 

Suprarenal extract, 237 

Thyroid extract, 234 
Aneurysm — 

Digitalis, 571 

Diuretin, 679 

Ergot, 505 

Iodides, 271 

Lead acetate, 757 
Angina Pectoris — 

Allyl tribromide, 646 

Amyl nitrite, 552 

Arsenic, 261 

Cactus, 580 

Chloral, 442 

Compound spirit of ether, 424 

Hydrogen dioxide, 372 

Phosphorus, 216 

Zinc sulphate, 762 
Anginose Scarlatina — 

Sodium sulphocarbolate, 329 
Anorexia — 

Simple bitters, 191 
Anosmia — 

Strychnine, 495 
Anthrax — 

Serum-therapy, 300 
Aortic Regurgitation — 

Adonidin, 576 

Cactus, 580 

Digitalis, 568 
Apepsia — 

Pepsin, 142 
Aphonia — 

Alum, 776 

Blisters, 785 

Bromides, 560 

Nitric acid, 156 

Potassium bichromate, 369 
Aphthae — 

Borax, 365 

Catechu, 742 

Magnesia, 177 

Red rose, 749 

Rhus glabra, 749 

Saccharine, 682 

Sodium bicarbonate, 175 

Sodium sulphocarbolate, 329 



Apoplexy — 

Croton oil, 710 
Appendicitis — 

Opium, 455 
Arrhythmia — 

Cactus, 580 

Nitroglycerin, 552 
Arsenical Poisoning — 

Hydrated sesquioxide of iron, 258 

Lime water, 177 

Magnesia, 262 
Arterio-sclerosis — 

Diuretin, 679 

Nitroglycerin, 552 
Arthritis, Chronic — 

Cod liver oil, 148 
Ascarides — 

Carbolic acid, 328 
Ascites — 

Colchicum, 275 

Colocynth, 716 

Copaiba, 674 

Diuretin, 678 

Elaterin, 710 
Aspergillus — 

Salicylic acid, 337 
Asphyxia — 

Alcohol, 596 

Mustard, 792 
Asthenopia — 

Physostigmine, 540 
Asthma — 

Adonidin, 576 

Allyl tribromide, 646 

Amyl nitrite, 552 

Antipyrin, 413 

Arsenic, 259 

Belladonna, 484 

Bromides, 559 

Caffeine, 585 

Chloral, 442 

Cocaine, 522 

Colchicum, 275 

Conium, 527 

Grindelia, 535 

Hydrogen dioxide, 372 

Hyoscyamus, 487 

Iodides, 271 

Ipecac, 638 

Lobelia, 640 

Nitre-paper, 617 

Opium, 463 

Physosligma, 541 

Pilocarpine, 621 

Quinine, 2^0 

Spartein sulphate, 539 

Stramonium, 486 

Strychnine, 497 

Terpin hydrate, 654 

Zinc oxide, 761 

Zinc sulphate, 762 
Atheroma — 

Cod liver oil, 148 



872 



CLINICAL INDEX. 



Aural Catarrh — 

Ammonium chloride, 643 

Balanitis — 

Alumnol, 343 

Silver nitrate, 770 
Bed-sores — 

Alcohol, 595 

Emollients, 801 

Glycerin, 803 

Lead tannate, 758 

Protecdves, 801 

Silver nitrate, 770 

Tannic acid, 737 
Belladonna-poisoning — 

Pilocarpine, 622 
Biliary Calculi — 

Sodium phosphate, 714 

Turpentine, 670 
Biliousness — 

Calomel, 250 

Citric acid, 162 

Seidlitz powder, 714 

Senna, 708 
Bites of Insects — 

Ammonia water, 601 

Olive oil, 805 

Rhus toxicodendron, 513 
Bites of Rabid Animals — 

Carbolic acid, 327 

Solution of chloride of antimony, 794 

Sulphuric acid, 155 
Bites of Venomous Reptiles — 

Solution of chloride of antimony, 794 
Bladder, Chronic Catarrh of — 

Tincture of cantharides, 789 
Bladder, Debility of— 

Fluid extract of blackberry, 750 

Tincture of cantharides, 789 
Bladder, Paralysis of — 

Arnica, 615 
Bladder, Spasm of — 

Cannabis, 475 
Blepharitis Marginalis — 

Yellow-oxide-of-mercury ointment, 249 
Boils- 
Belladonna ointment, 481 

Cantharidal blister, 788 

Colloidal silver, 772 

Glycerin, 803 

Menthol, 395 

Silver nitrate, 770 

Tar, 650 
Brain, Congestion of — 

Elaterin, 710 
Bright's Disease — 

Alkalies, 176 

Cod liver oil, 148 

Digitalis, 57 1 

Gallic acid, 739 

Iron, 209 

Pilocarpine, 621 

Scoparius, 579 

Spirit of nitrous ether, 624 



Bright's Disease — 

Strophanthus, 575 
Bromidrosis — 

Chloral, 441 

Hydrastine ointment, 510 

Potassium permanganate, 367 
Bronchitis — 

Acetanilid, 41 1 

Alum, 776 

Ammoniacum, 407 

Ammonium carbonate, 602 

Ammonium chloride, 643 

Ammonium preparations, 177 

Apomorphine, 630 

Arsenic, 259 

Asafetida, 407 

Balsam of tolu, 645 

Benzoic acid, 356 

Buchu, 664 

Burgundy-pitch plaster, 784 

Calomel, 25 1 

Cannabis, 475 

Codeine, 467 

Cod liver oil, 148 

Colchicum, 275 

Copaiba, 674 

Creosote, 330 

Demulcents, 801 

Digitalis, 570 

Eucalyptus, 363 

Grindelia, 535 

Hedeoma, 734 

Hydrastis, 510 

Hyposulphites, 375 

Iodides, 271 

Iron, 209 

Lime water, 177 

Liquorice, 647 

Lobelia, 640 

Myrrh, 358 

Nitric acid, 156 

Onion poultice, 646 

Opium, 463 

Physostigma, 541 

Sanguinaria, 284 

Senega, 652 

Squill, 662 

Strychnine, 497 

Sulphur, 697 

Syrup of garlic, 646 

Tar, 650 

Tartar emetic, 634 

Terebene, 653 

Terpin hydrate, 654 

Turpentine, 670 

Wild cherry, 19 1 

Wine of ipecac, 636 
Bronchorrhea — 

Alum, 776 

Asafetida, 407 

Carbolic acid, 327 

Copaiba, 674 

Eucalyptus, 363 

Gallic acid, 739 






CLINICAL INDEX. 



873 



Bronchorrhea — 

Lead acetate, 757 

Myrrh, 358 

Pilocarpine, 611 

Senega, 652 

Terebene, 653 

Turpentine, 670 

Zinc oxide, 761 
Bruises — 

Ammonium chloride, 643 

Arnica, 615 

Camphor liniment, 406 

Hamamelis, 746 

Olive oil, 805 

Potassium nitrate, 616 

Solution of lead subacetate, 757 

Tansy, 732 
Buboes — 

Ammonium chloride, 643 

Hydrogen dioxide, 372 

Iodoform, 352 

Phytolacca, 61 1 

Salol, 340 

Tincture of iodine, 270 
Buccal Ulcer — 

Geranium, 747 

Red rose, 749 
Burns — 

Acacia, 807 

Bismuth subgallate, 780 

Bismuth subnitrate, 780 

Carbolic acid, 327 

Cocaine ointment, 521 

Hamamelis, 746 

Lead carbonate, 757 

Lime water, 175 

Linseed oil, 806 

Menthol, 395 

Nutgall ointment, 740 

Ointment of rose, 740 

Olive oil, 805 

Phytolacca, 611 

Protectives, 801 

Rhus toxicodendron, 513 

Salol, 340 

Sodium bicarbonate, 175 

Terebene, 653 

Zinc oxide, 761 

Calculi — 

Ammonium benzoate, 357 
Callositas — 

Salicylic acid, 336 
Cancer — 

Arsenic, 258 

Bromine, 799 

Calendula, 191 

Carbolic acid, 327 

Conium, 527 

Hydrastine ointment, 510 

Podophyllum, 719 

Sulphuric acid, 155 

Thyroid extract, 234 

Zinc chloride, 798 



Cancer — 

Zinc sulphate, 762 
Cancer of Cervix — 

Nitric acid, 155 
Cancer of Stomach — 

Pepsin, 142 
Cancer of Tongue — 

Potassium permanganate, 377 
Cancer of Uterus — 

Chloral, 441 

Potassium permanganate, 367 

Tannic acid, 737 
Cancer of Vagina — 

Potassium permanganate, 367 
Cancrum Oris — 

Bismuth subnitrate, 780 

Zinc sulphate, 762 
Capillary Bronchitis — 

Alcohol, 596 

Ammonium iodide, 271 

Serpentaria, 192 

Turpentine, 670 
Carbuncle — 

Belladonna ointment, 483 

Cantharidal blister, 788 

Glycerin, 803 

Hamamelis, 746 

Serum therapy, 319 
Cardiac Depression — 

Caffeine, 584 
Cardiac Irritability — 

Bromides, 560 
Cardiac Pain — 

Belladonna, 485 
Caries of the Temporal Bone- 
Turpentine, 669 
Catarrh — 

Benzoic acid, 356 

Borax, 365 

Boric acid, 356 

Dobell's solution, 175 

Hydrastis, 510 

Potassium permanganate, 367 

Sodium sulphocarbolate, 329 

Suprarenal extract, 236 
Catarrh of Stomach — 

Capsicum, 386 
Cellulitis— 

Digitalis, 570 
Cerebral Anemia — 

Phosphorus, 217 
Cerebral Hemorrhage- 
Phosphorus, 217 
Cerebral Hyperemia— 

Belladonna, 485 

( olchicum, 276 

Ergot, 506 
Cerebral Neoplasm — 

Thyroid extract, 234 
Cerebro-spinal Meningitis — 

Aconite, 606 

Alcohol, 596 

I'.listers, 785 

Ergot, 506 



8 7 4 



CLINICAL INDEX. 



Cerebro- spinal Meningitis — 

Gelsemium, 533 
Cerumen, Impacted — 

Glycerin, 803 

Liquor potassae, 174 

Papain, 144 
Cervix, Erosion of — 

Glycerin, 803 
Charing of the Skin— 

Lycopodium, 810 
Chancre — 

Acetanilid, 410 

Alumnol, 343 

Bismuth benzoate, 357 

Bismuth subnitrate, 780 

Fluid extract of hydrastis, 510 

Iodoform, 352 

Solution of chloride of antimony, 794 

Sulphuric acid, 155 
Chancroid — 

Acetanilid, 410 

Bismuth benzoate, 357 

Carbolic acid, 327 

Fluid extract of hydrastis, 510 

Iodoform, 352 

Potassium bichromate, 369 

Salicylic acid, 336 

Silver nitrate, 770 
Chapping — 

Bismuth subnitrate, 780 

Camphor ice, 406 

Compound tincture of benzoin, 356 

Glycerin, 803 

Ointment of rose, 749 

Tragacanth, 809 
Chilblain — 

Aconite, 605 

Alum, 776 

Ammonia liniment, 601 

Camphor liniment, 406 

Capsicum, 386 

Carbolic acid, 327 

Nutgall ointment, 740 

Rhus toxicodendron, 513 
Chills— 

Strophanthus, 575 
Chloasma — 

Nitric acid, 155 

Tincture of iodine, 270 
Chloroform -poisoning — 

Ammonia, 601 

Amyl nitrite, 552 

Atropine, 485 

Strychnine, 498 
Chlorosis — 

Aloes, 700 

Arsenic, 261 

Hypophosphites, 220 

Iron, 208 

Manganese, 212 

Potassium chlorate, 371 

Red wine, 597 

Strychnine, 496 

Thyroid extract, 234 



Cholera — 

Bismuth subnitrate, 780 

Calomel and opium, 251 

Camphor, 407 

Opium, 463 

Salicylic acid, 338 

Salol, 340 

Serum-therapy, 315 

Sulphuric acid, 157 
Cholera Infantum — 

Bismuth subnitrate, 780 

Lead acetate, 757 
Cholera Morbus — 

Opium, 463 

Salol, 340 
Chordee — 

Camphor, 407 

Cannabis, 475 

Colchicum, 276 

Hop poultice, 470 

Monobromated camphor, 407 
Chorea — 

Acetanilid, 41 1 

Arsenic, 260 

Asafetida, 407 

Cerium oxalate, 782 

Chloral, 442 

Cocaine, 522 

Conium, 527 

Copper sulphate, 765 

Curare, 541 

Exalgine, 416 

Gelsemium, 532 

Hyoscine, 489 

Iron, 209 

Opium, 463 

Picrotoxin, 500 

Quinine, 230 

Salicylic acid, 337 

Silver nitrate, 770 

Zinc oxide, 761 

Zinc sulphate, 762 
Cinchonism — 

Diluted hydrobromic acid, 560 
Cirrhosis of Kidneys — 

Potassium iodide, 271 
Cirrhosis of Liver — 

Calomel, 250 

Iodoform, 352 

Potassium iodide, 271 
Colchicum-poisoning — 

Potassium permanganate, 368 
Colds- 
Aconite, 605 

Citric acid, 162 

Fluid extract of pilocarpus, 622 

Mustard bath, 792 
Colic- 
Belladonna, 485 

Chloral, 442 

Ginger, 393 

Hedeoma, 734 

Hyoscyamus, 489 

Tansy, 732 



CLINICAL INDEX. 



«7: 



Collapse — 

Alcohol, 596 

Digitalis, 570 
Coma — 

Mustard, 792 
Comedo — 

Salicylic acid, 337 

Sulphur, 696 
Condylomata — 

Chromic acid, 795 

Copper sulphate, 765 

Resorcin, 345 

Solution of chloride of antimony, 794 
Congestion of Brain — 

Elaterin, 710 
Congestion of Lungs — 

Elaterin, 710 

Ergot, 506 
Congestive Chill — 

Opium, 463 
Conjunctivitis — 

Alum, 776 

Bismuth subnitrate, 780 

Boric acid, 365 

Copper sulphate, 765 

Gallicine, 740 

Hydrastine hydrochlorate, 510 

Morphine sulphate, 462 

Nitrate of sanguinarine, 284 

Silver nitrate, 769 

Zinc acetate, 762 

Zinc sulphate, 762 
Constipation — 

Aloes, 700 

Arsenic, 261 

Asafetida, 407 

Belladonna, 484 

Cascara sagrada, 693 

Cassia fistula, 690 

Castor oil, 692 

Colocynth, 716 

Euonymus, 704 

Glycerin, 804 

Hydrastine, 510 

Jalap, 517 

Magnesia, 694 

Magnesium carbonate, 694 

Manna, 695 

Oxgall, 701 

Physostigma, 541 

Podophyllum, 719 

Rhubarb, 693 

Senna, 708 

Sodium salts, 714 

Strychnine, 496 

Sulphur, 697 

Taraxacum, 698 
Contusions — 

Alcohol, 595 

Calendula, 191 

Solution of ammonium acetate, 623 
Convalescence — 

Alcohol, 595 

Cod liver oil, 149 



Convalescence- 
Simple bitters, 191 

Wine of coca, 522 
Convulsions — 

Chloral, 442 
Corneal Ulcer — 

Physostigmine, 540 
Corns — 

Acetic acid, 161 

Arsenic, 258 

Glacial acetic acid, 797 

Potassium bichromate, 369 

Salicylic acid, 336 
Corrosive Poisoning — 

Olive oil, 805 
Coryza — 

Ammonium chloride, 643 

Antipyrine, 413 

Arsenic, 261 

Camphor, 406 

Camphoric acid, 408 

Cocaine, 521 

Dover's powder, 464 

Gelsemium, 533 

Glycerin, 803 

Iodine, vapor of, 270 

Oil of Scotch fir, 648 

Salicylic acid, 337 

Solution of ammonium acetate, 623 

Whiskey, 597 
Cough — 

Apomorphine, 630 

Benzoic acid, 356 

Bromides, 559 

Cannabis, 475 

Cerium oxalate, 782 

Confine, 527 

Cubeb, 677 

Geranium, 747 

Grindelia, 535 

Hydrocyanic acid, 548 

Ipecac, 636 

Lactucarium, 471 

Linseed tea, 806 

Liquorice, 647 

Spirit of nitrous ether, 624 

Strychnine, 497 

Sumbul, 543 

Terebene, 653 

Turpentine, 670 
Cracked Nipples- 
Bismuth subnitrate, 780 

Brandy, 595 

Chloral, 441 

Compound tincture of ben/oin. 356 

White oak, 741 
Cretinism — 

Thyroid extract, 2 ; I 
Croup — 

Alum. 770 

c, 637 
1 actic acid, 158 
Papain, 1 44 
Pepsin, 142 



876 



CLINICAL INDEX. 



Croup — 

Senega, 652 

Silver nitrate, 770 

Tartar emetic, 634 

Zinc sulphate, 762 
Crusts, Removal of — 

Olive oil, 805 
Cuts- 
Isinglass, 810 
Cystitis — 

Antipyrine, 413 

Belladonna, 485 

Benzoic acid, 357 

Boric acid, 365 

Buchu, 664 

Camphoric acid, 408 

Copaiba, 674 

Demulcents, 801 

Elm, 808 

Gallic acid, 739 

Hamamelis, 746 

Hydrogen dioxide, 372 

Hyoscyamus, 489 

Lactic acid, 159 

Myrrh, 358 

Piperazin, 681 

Quinine, 229 

Resorcin, 346 

Saccharin, 682 

Salol, 340 

Turpentine, 670 

Deafness — 

Iodine, vapor of, 270 
Deglutition, Painful — 

Olive oil, 805 
Delirium of Fevers — 

Diluted hydrobromic acid, 560 
Delirium Tremens — 

Arnica, 615 

Aromatic spirit of ammonia, 601 

Bromides, 559 

Bromoform, 560 

Camphor, 407 

Chamomile, 191 

Digitalis, 571 

Hyoscine, 489 

Strychnine, 497 

Tincture of lupulin, 470 

Zinc oxide, 762 
Dementia — 

Hyoscine, 489 
Dermatitis — 

Ichthyol, 348 

Magnesium carbonate, 175 

White oak, 741 
Diabetes Insipidus — 

Ergot, 506 

Gallic acid, 739 

Lime water, 177 

Pilocarpine, 722 

Valerian, 408 
Diabetes Mellitus— 

Alum, 776 



Diabetes Mellitus — 

Ammonium bromide, 559 
Antipyrine, 413 
Arsenic, 261 
Cod liver oil, 148 
Glycerin, 804 
Guaiacol, 333 
Hydrogen dioxide, 372 
Iodoform, 352 
Iron, 209 
Lactic acid, 159 
Pancreas extracts, 238 
Phosphoric acid, 156 
Piperazin, 681 
Saccharin, 682 
Strychnine, 498 
Thymol, 397 
Valerian, 408 
Diarrhea — 
Alum, 776 
Arnica, 615 
Arsenic, 260 
Bismuth phosphate, 781 
Bismuth subgallate, 780 
Bismuth subnitrate, 780 
Bismuth tannate, 780 
Borax, 366 
Boric acid, 366 
Brandy, 596 
Bromides, 559 
Caffeine, 585 
Camphor, 407 
Catechu, 742 
Cerium oxalate, 782 
Chalk mixture, 177 
Colchicum, 275 
Copaiba, 674 
Copper sulphate, 765 
Demulcents, 801 
Digitalis, 571 
Elm, 808 
Ergot, 506 
Erythrophleum, 663 
Fluid extract of blackberry, 750 
Gallic acid, 739 
Ginger, 393 
Hematoxylon, 745 
Hope's camphor mixture, 156 
Hydronaphtol, 344 
Infusion of nutgall, 741 
Ipecac, 637 
Iron, 209 
Kino, 743 
Krameria, 744 
Lactic acid, 159 
Lead acetate, 757 
Lime water, 177 
Pepsin, 142 
Prepared chalk, 177 
Quinine, 230 
Resorcin, 346 
Rhubarb, 703 
Salicylic acid, 23^ 
Salol, 340 



CLINICAL INDEX. 



877 



Diarrhea — 

Sodium nitrate, 617 

Sodium sulphocarbolate, 329 

Strychnine, 496 

Sulphuric acid, 157 

Tannic acid, 737 

Thymol, 397 

White oak, 741 

Zinc oxide, 761 

Zinc sulphate, 762 

Zinc sulphocarbolate, 329 
Digestive Disorders — 

Nuclein, 238 
Digestive Organs, Inflamed Condi- 
tions of — 

Althaea, 808 
Dilatation of Heart — 

Digitalis, 569 

Ergot, 505 
Dilatation of Stomach — 

Carbolic acid, 328 

Physostigma, 541 
Diphtheria — 

Alcohol, 596 

Alum, 776 

Balsam of tolu, 645 

Bichloride of mercury, 25 1 

Chloral, 441 

Chlorine water, 376 

Eucalyptus, 363 

Gallic acid, 739 

Hydrochloric acid, 154 

Hydronaphtol, 344 

Hyposulphites, 375 

Ipecac, 637 

Iron, tincture of chloride of, 208 

Lactic acid, 158 

Papain, 144 

Pepsin, 142 

Potassium permanganate, 367 

Resorcin, 345 

Salicylic acid, 337 

Serum-therapy, 301 

Sodium sulphocarbolate, 329 

Sulphurous acid, 373 

Tartaric acid, 161 

Thymol, 397 

Turpentine, 670 

Zinc sulphate, 762 
Diphtheritic Paralysis — 

Strychnine, 497 
Dropsy — 

Caffeine, 584 

Copaiba, 674 

Digitalis, 571 

Diuretin, 678 

Iris, 705 

Jalap, 717 

Juniper, 666 

Potassium bitartrate, 176 

Potassium iodide, 271 

Salines, 714 

Solution of ammonium acetate, 623 

Squill, 662 



Dryness of Mouth — 

Glycerin, 803 
Duodenal Catarrh — 

Salol, 340 

Sanguinaria, 284 

Sodium phosphate, 714 
Dysentery — 

Acacia, 807 

Alum, 776 

Arnica, 615 

Bismuth phosphate, 781 

Bismuth subgallate, 780 

Bismuth subnitrate, 780 

Carbolic acid, 328 

Colchicum, 275 

Copaiba, 674 

Copper sulphate, 765 

Corrosive chloride of mercury, 250 

Demulcents, 801 

Elm, 808 

Ergot, 506 

Erythrophleum, 663 

Gallic acid, 739 

Hematoxylon, 745 

Hydronaphtol, 344 

Infusion of nutgall, 741 

Ipecac, 637 

Iron, 209 

Kino, 743 

Krameria, 744 

Lactic acid, 159 

Lead acetate, 757 

Lime water, 177 

Olive oil, 805 

Opium, 463 

Quinine, 230 

Rhubarb, 703 

Silver nitrate, 770 

Sodium nitrate, 617 

Tannic acid, 737 

Thymol, 397 

White oak, 741 

Zinc oxide, 761 

Zinc sulphate, 762 
Dysmenorrhea — 

Acetanilid, 411 

Ammonium chloride, 643 

Amyl nitrate, 552 

Apioline, 733 

Arsenic, 259 

Black haw, 544 

Camphor, 407 

Cannabis, 475 

Caulophyllum, 731 

Ergot, 505 

( telsemium, 533 

( ruaiac, 279 

Ilvdrastine, 5 1 1 

Picrotoxin, 501 

Sanguinaria, 2S4 

Solution of ammonium acet 

Spirit of nitrous ether, oj \ 

Sumbul, 543 



878 



CLINICAL INDEX. 



Dyspepsia — 

Alcohol, 595 

Alkalies, 176 

Ammonium preparations, 1 77 

Asafetida, 407 

Bismuth phosphate, 781 

Carbolic acid, 328 

Cerium oxalate, 781 

Colchicum, 275 

Diastase, 144 

Erythrophleum, 663 

Hematoxylon, 745 

Hops, 470 

Hydrochloric acid, 155 

Hydrocyanic acid, 548 

Ipecac, 637 

Lactic acid, 159 

Manganese sulphate, 212 

Myrrh, 358 

Pepsin, 142 

Potassium bichromate, 369 

Quinine, 230 

Resorcin, 346 

Simple bitters, 191 

Sodium sulphocarbolate, 329 

Strontium bromide, 560 

Strychnine, 495 

Sulphurous acid, 374 

Taraxacum, 698 

Terebene, 653 

Xanthoxylum, 287 

Zinc sulphate, 762 
Dysphonia — 

Bromides, 560 
Dyspnea — 

Amyl nitrite, 552 

Aspidosperma, 542 

Bromides, 560 

Grindelia, 535 

Hydrogen dioxide, 372 

Ear, Diseases of — 

Aristol, 352 

Calendula, 191 

Ichthyol, 347 

Iodoform, 352 

Liquor potassae, 174 

Nitric acid, 155 

Sodium bicarbonate, 175 
Earache — 

Hops, 470 

Oil of cloves, 389 

Onion, 646 
Ecchymoses — 

Arnica, 615 
Eclampsia, Infantile — 

Picrotoxin, 500 
Eclampsia, Puerperal — 

Amyl nitrite, 552 

Conium, 527 

Veratrum viride, 610 
Ecthyma — 

Quinine, 230 

Solution of lead subacetate, 757 



Ecthyma — 

Sulphur, 696 
Eczema — 

Anderson's powder, 406 

Arsenic, 259 

Belladonna, 484 

Bismuth subgallate, 780 

Black wash, 175 

Calomel, 249 

Carbolic acid, 327 

Cod liver oil, 148 

Coffee, 584 

Colchicum, 275 

Eucalyptus, 362 

Eugallol, 739 

Fluid extract of pilocarpus, 621 

Galla, 740 

Gallicine, 740 

Gelsemium, 533 

Glycerite of starch, 803 

Grindelia, 535 

Hamamelis, 746 

Hydrocyanic acid, 548 

Ichthyol, 347 

Lead acetate, 756 

Lead iodide, 757 

Lenigallol, 739 

Lycopodium, 810 

Menthol, 395 

Papain, 144 

Phytolacca, 61 1 

Potassium chlorate, 371 

Prepared chalk, 175 

Resorcin, 345 

Rhus toxicodendron, 513 

Salicylic acid, 336 

Salol, 340 

Sodium carbonate, 175 

Solution of lead subacetate, 757 

Sulphur, 696 

Tannic acid, 737 

Tar, 650 

Xeroform, 779 

Yellow wash, 175 

Zinc carbonate, 762 

Zinc oxide, 761 

Zinc sulphate, 762 
Edema of the Prepuce — 

Glycerin, 803 
Emphysema — 

Physostigma, 541 

Terebene, 653 

Turpentine, 670 
Empyema — 

Hydrogen dioxide, 372 

Tincture of iodine, 270 
Endarteritis — 

Iodides, 270 

Mercury, 250 
Endocarditis — 

Blisters, 785 

Quinine, 230 
Endometritis — 

Carbolic acid, 327 



CLINICAL INDEX. 






Endometritis — 

Glycerite of tannic acid, 803 

Hydrogen dioxide, 372 

Solution of zinc chloride, 799 

Tincture of iodine, 270 
Enlarged Tonsils — 

Chromic acid, 795 

Zinc sulphate, 762 
Enteralgia — 

Belladonna, 484 

Hyoscyamus, 489 
Enteritis — 

Demulcents, 801 
Entero-colitis — 

Salicylic acid, 338 
Enuresis — 

Camphoric acid, 407 

Rhus glabra, 749 
Epididymitis — 

Ammonium chloride, 643 

Mercurial ointment, 249 

Silver nitrate, 770 
Epilepsy — 

Acetanilid, 411 

Amyl nitrite, 552 

Borax, 366 

Bromides, 559 

Chloral, 442 

Copper sulphate, 765 

Curare, 541 

Digitalis, 571 

Hydrastine hydrochlorate, 511 

Hydrogen dioxide, 372 

Picrotoxin, 500 

Silver nitrate, 770 

Zinc oxide, 761 

Zinc sulphate, 762 
Epistaxis — 

Acetanilid, 410 

Acetic acid, 1 61 

Alum, 775 

Arnica, 615 

Digitalis, 571 

Ether, 424 

Geranium, 747 

Hamamelis, 746 

Kino, 743 

Krameria, 744 

Sulphuric acid, 155 
Epithelioma — 

Bismuth subnitrate, 780 

Lead nitrate, 758 

Nitric acid, 155 

Pyrogallol, 739 

Zinc chloride, 798 
Erysipelas — 

Alcohol, 597 

Antistreptococcic serum, 315 

Belladonna, 485 

Bismuth subnitrate, 780 

Carbolic acid, 327 

Colloidal silver, 772 

Fluid extract of pilocarpus, 62] 

Glycerin, 804 



Erysipelas — 

Guaiacol, 333 

Hyposulphites, 375 

Ichthyol, 347 

Iron, 209 

Lead carbonate, 757 

Lycopodium, 810 

Pilocarpine, 621 

Prepared chalk, 175 

Quinine, 229 

Rhus toxicodendron, 513 

Salicylic acid, 336 

Solution of lead subacetate, 757 

Tannic acid, 737 

Turpentine, 670 

Zinc oxide, 761 
Erythema — 

Anderson's powder, 406 

Bismuth subnitrate, 780 

Ergot, 506 

Hamamelis, 746 

Hydrocyanic acid, 548 

Ichthyol, 347 

Lead acetate, 756 

Rhus toxicodendron, 513 
Exanthemata — 

Acetanilid, 411 

Acetic acid, 161 

Ammonium carbonate, 601 

Ammonium chloride, 643 

Camphor, 407 

Cod liver oil, 148 

Opium, 464 

Solution of ammonium acetate, 621 
Excoriations — 

Acacia, 807 

Glycerin, 803 

Olive oil, 805 

Protectives, 801 

Tar, 650 
Exophthalmic Goiter — 

Belladonna, 485 

Bromides, 560 

Digitalis, 570 

Ergot, 506 

Thyroid extract, 233 
Eye, Diseases of — 

Fluid extract of red rose, 749 

Iodoform, 352 

Physostigmine, 540 

Fainting — 

Ammonia water, 601 
Fatty Heart— 

Caffeine, 5S4 
Fauces, Inflammation of — 

Salicylic acid, 337 
Favus — 

( arbolic acid, 327 

Gallanol, 739 

I Ivnosulphites, 375 

Phytolacca, 610 
Febrile Affections — 

Acacia, S07 



88o 



CLINICAL INDEX. 



Febrile Affections — 

Acetanilid, 410 

Aconite, 605 

Ammonium carbonate, 601 

Citric acid, 162 

Demulcents, 801 

Hydrochloric acid, 155 

Opium, 464 

Potassium nitrate, 617 

Sodium bromide, 559 

Spirit of nitrous ether, 624 

Tartar emetic, 634 
Felons — 

Chloral, 442 

Cocaine, 521 

Silver nitrate, 770 

Solution of lead subacetate, 757 
Fermentation — 

Salicylic acid, 338 
Fissured Nipples — 

Galla, 740 

Glycerin, 803 

Lead nitrate, 757 

Tar, 650 

Zinc oxide, 761 
Fistula — 

Calcium phosphate, 220 

Cantharidal blister, 788 

Cod liver oil, 148 

Hydrogen dioxide, 372 

Iodoform, 352 
Fistulous Discharges — 

Quinine, 230 
Fistulous Openings, to Dilate — 

Elm, 808 
Flatulence — 

Anise, 380 

Asafetida, 407 

Brandy, 596 

Camphor, 407 

Compound spirit of ether, 424 

Ginger, 393 

Glycerin, 804 

Hops, 470 

Physostigma, 541 

Salicylic acid, 338 

Spirit of nitrous ether, 624 

Turpentine, 670 
Freckles — 

Hamamelis, 746 

Potassium nitrate, 617 
Frost-bite — 

Alcohol, 595 

Compound tincture of benzoin, 356 

Hamamelis, 746 

Galactorrhea — 

Ergot, 506 
Gall-stones — 

Olive oil, 805 
Gangrene — 

Ammonium chloride, 643 

Bromine, 799 

Carbolic acid, 327 



Gangrene — 

Hematoxylon, 745 

Lead nitrate, 758 

Nitric acid, 155 

White oak, 741 
Gangrene of Lungs — 

Carbolic acid, 327 

Eucalyptus, 363 

Hyposulphites, 375 

Salicylic acid, 337 
Gangrene of Pharynx — 

Alum, 776 

Copper sulphate, 765 
Gangrenous Sores — 

Solution of chlorinated soda, 377 
Gastralgia — 

Acetanilid, 41 1 

Arsenic, 260 

Belladonna, 484 

Bismuth phosphate, 781 

Brandy, 596 

Coca, 522 

Compound spirit of ether, 424 

Manganese dioxide, 212 

Menthol, 396 

Resorcin, 346 

Silver nitrate, 770 

Silver oxide, 770 

Zinc oxide, 762 
Gastric Acidity — 

Glycerin, 804 
Gastric Catarrh — 

Iodoform, 352 

Salicylic acid, 338 

Simple bitters, 191 

Strychnine, 496 
Gastric Fermentation — 

Hyposulphites, 375 

Potassium permanganate, 367 
Gastric Pain — 

Cantharidal blister, 789 

Hydrocyanic acid, 548 
Gastric Ulcer — 

Arsenic, 261 

Bismuth subnitrate, 780 

Lead acetate, 757 

Manganese dioxide, 212 

Potassium bichromate, 369 

Silver nitrate, 770 

Silver oxide, 770 
Gastritis — 

Acacia, 807 

Arsenic, 260 

Bismuth subnitrate, 780 

Demulcents, 805 

Lead acetate, 757 

Resorcin, 346 

Silver nitrate, 770 
Gastrodynia — 

Codeine, 468 
General Debility — 

Digitalis, 570 
Gingivitis — 

Borax, 365 



CLINICAL INDEX. 



88 r 



Gingivitis — 

Boric acid, 365 

Hydronaphthol, 344 
Glandular Enlargements — 

Solution of ammonium acetate, 623 
Gleet- 
Alum, 776 

Buchu, 664 

Copaiba, 674 

Copper sulphate, 765 

Geranium, 765 

Krameria, 744 

Lead acetate, 756 

Tar water, 650 

Tincture of cantharides, 789 

Turpentine, 670 
Glossitis — 

Chromic acid, 795 
Goiter — 

Ammonium chloride, 643 

Carbolic acid, 328 

Red-iodide-of-mercury ointment, 250 

Thyroid extract, 233 

Tincture of iodine, 270 
Gonorrhea — 

Acetic acid, 161 

Alum, 776 

Alumnol, 343 

Argentol, 771 

Argonin, 771 

Bismuth subnitrate, 780 

Bismuth tannate, 780 

Boric acid, 365 

Buchu, 664 

Cannabis, 475 

Catechu, 742 

Chloral, 441 

Chromic acid, 795 

Colchicum, 276 

Copaiba, 674 

Copper sulphate, 765 

Geranium, 747 

Glycerin, 803 

Grindelia, 535 

Hamamelis, 747 

Hydrastin, 509 

Hydrogen dioxide, 372 

Kino, 743 

Lead acetate, 756 

Oil of santal, 674 

Potassium permanganate, 367 

Protargol, 772 

Quinine bisulphate, 229 

Resorcin, 346 

Salol, 340 

Silver nitrate, 770 

Sodium sulphocarbolate, 329 

Solution of zinc chloride, 799 

Tannic acid, 737 

Turpentine, 670 

Zinc acetate, 762 

Zinc sulphate, 762 
Gout — 

Alkalies, 175 
56 



Gout- 
Arnica, 615 

Colchicum, 275 

Guaiac, 279 

Lactic acid, 159 

Lithium carbonate, 175 

Piperazin, 681 

Potassium iodide, 271 

Salicylic acid, 337 

Tincture of iodine, 270 
Gouty Diathesis — 

Lithium preparations, 177 

Sodium salts, 714 
Gouty Sores — 

Piperazin, 681 
Granular Lids — 

Bismuth subnitrate, 780 
Granulations — 

Alum, 775 

Nitric acid, 155 
Gummata — 

Iodides, 270 

Hay Fever — 

Ammonium iodide, 272 

Arsenic, 261 

Cannabis, 475 

Cocaine, 521 

Grindelia, 535 

Quinine, 230 

Resorcin, 346 

Terpin hydrate, 654 
Headache — 

Acetanilid, 41 1 

Aromatic spirit of ammonia, 601 

Arsenic, 260 

Bromides, 558 

Butyl-chloral hydrate, 447 

Caffeine, 585 

Cannabis, 475 

Ergot, 506 

Menthol, 395 

Quinine, 230 

Salicylic acid, 337 

Spirit of nitrous ether, 624 

Valerian, 408 
Heart, Fatty Degeneration of— 

Iodine, 271 
Heart, Functional Disorders of — 

Cactus, 5 So 
Heart, Functional Irregularity of- 

Adonidin, 576 

Strychnine, 496 
Heart, Valvular Diseases of — 

Iodine, 271 
Hematemesis — 

Alum, 776 

(lallic acid, 739 

Ipecac, 637 

Iron, 209 

Sulphuric acid, 197 

Turpentine, 670 
Hematuria — 

Alum, 776 



882 



CLINICAL INDEX. 



Hematuria— 
Rhus glabra, 748 
Turpentine, 670 
Hemiplegia — 

Strychnine, 497 
Hemoptysis — 
Acetanilid, 410 
Arnica, 615 
Digitalis, 571 

Fluid extract of hydrastis, 511 
Gelsemium, 533 
Geranium, 747 
Iodoform, 352 
Ipecac, 638 
Lead acetate, 757 
Tannic acid, 737 
Turpentine, 670 
White oak, 741 
Hemorrhage — 
Alcohol, 596 
Alum, 775 
Digitalis, 570 
Ergot, 506 
Hamamelis, 746 
Iron, 209 
Lead acetate, 757 
Opium, 464 
Pyrogallol, 739 
Turpentine, 670 
Hemorrhage, Intestinal — 
Alum, 776 
Gallic acid, 739 
Sulphuric acid, 157 
Hemorrhage, Renal — 

Gallic acid, 739 
Hemorrhage, Uterine — 
Alcohol, 595 
Cinnamon, 382 
Cotarnine, 5 II 
Ergot, 505 
Hydrastine, 510 
Ipecac, 637 
Krameria, 744 
Nitric acid, 155 
Sulphuric acid, 157 
Senegin, 652 
White oak, 741 
Hemorrhoids — 

Belladonna ointment, 484 
Chromic acid, 795 
Cocaine, 521 
Ergot, 505 
Galla, 740 
Gallic acid, 739 
Hamamelis, 746 
Iodoform, 352 
Krameria, 744 
Lead acetate, 75^ 
Manna, 695 
Menthol, 395 
Nitric acid, 155 
Potassium bromide, 558 
Rhubarb, 703 
Stramonium ointment, 487 



Hemorrhoids — 

Sulphur, 697 

Tannic acid, 737 

White oak, 741 
Hepatic Cirrhosis — 

Podophyllum, 719 
Hepatic Congestion — 

Calomel, 250 

Gamboge, 711 

Taraxacum, 698 
Hepatic Disorders — 

Diluted nitrohydrochloric acid, 156 
Hepatitis — 

Calomel, 251 
Hernia — 

Caffeine, 585 

Fluid extract of white oak, 741 
Herpes — 

Aconite, 605 

Bismuth subgallate, 780 

Galla, 740 

Hamamelis, 746 

Ichthyol, 348 

Lycopodium, 810 

Rhus toxicodendron, 513 

Salicylic acid, 337 

Tannic acid, 737 
Herpes of Buccal Cavity — 

Potassium chlorate, 371 
Hiccough — 

Chloral, 442 

Coffee, 585 

Compound spirit of ether, 424 

Infusion of mustard, 792 

Nitroglycerin, 792 

Pilocarpine, 621 
Hoarseness — 

Borax, 365 

Boric acid, 365 

Compound tincture of benzoin, 356 

Cubeb, 677 ■ 

Licorice, 647 

Potassium bichromate, 569 
Hodgkin's Disease — 

Arsenic, 259 
Hydrocele — 

Chloral, 441 

Tincture of iodine, 270 
Hydrocyanic -acid Poisoning — 

Ammonia, 601 

Potassium permanganate, 368 
Hydrophobia — 

Coniine, 527 

Curare, 530 

Opium, 463 
Hydrothorax — 

Cantharidal blisters, 788 
Hyperidrosis — 

Chloral, 441 

Chromic acid, 795 

Hamamelis, 746 

Hydrastine ointment, 510 

Tannic acid, 737 



CLINICAL INDEX. 



883 



Hyperpyrexia, Rheumatic — 

Salicylic acid, 337 
Hypertrophy of Heart — 

Aconite, 605 

Lead acetate, 757 
Hypochondria — 

Colchicum, 276 

Diluted nitre-hydrochloric acid, 156 

Valerian, 408 
Hysteria — 

Allyl tribromide, 646 

Asafetida, 407 

Belladonna, 484 

Compound spirit of ether, 424 

Copper sulphate, 765 

Oil of rue, 731 

Sanguinaria, 284 

Sumbul, 543 

Tansy, 732 

Valerian, 408 

Zinc oxide, 761 

Zinc sulphate, 762 
Hysterical Convulsions — 

Hyoscine, 489 
Hysterical Paralysis — 

Blisters, 785 

Ileo-colitis — 

Calomel, 250 

Gray powder, 250 
Impetigo — 

Hyposulphites, 375 

Lead acetate, 756 

Quinine, 230 

Salicylic acid, 336 

Sulphur, 696 

Tannic acid, 737 
Impotence — 

Alcohol, 597 

Cannabis, 475 

Phosphorus, 217 

Sanguinaria, 284 

Tincture of cantharides, 789 
Incontinence of Urine — 

Ammonium benzoate, 357 

Belladonna, 484 

Buchu, 664 

Ergot, 506 

Hyoscyamus, 489 

Iron, 209 

Krameria, 744 

Rhus glabra, 748 

Rhus toxicodendron, 513 

Tincture of cantharides, 789 

Tincture of nux vomica, 495 

Turpentine, 670 
Indigestion — 

Bromides, 559 

Hydrochloric acid, 155 
Infantile Convulsions — 

Allyl tribromide, 646 

Asafetida, 407 

Bromides, 559 

Chloral, 442 



Inflamed Gums — 

Hamamelis, 746 
Inflammation of Nose — 



Carbolic acid. 



3 2 7 



Inflammation of Throat — 

Carbolic acid, 327 
Inflammations — 

Hop poultice, 470 

Linseed poultice, 8c6 

Mercury, 250 
Inflammatory Exudates, to Hasten 
Absorption of — 

Rubefacients, 783 
Influenza — 

Acetanilid, 41 1 

Salicylic acid, 338 

Serum-therapy, 317 

Solution of ammonium acetate, 623 
Ingrowing Toe-nail — 

Alum, 776 

Liquor potassse, 174 
Insanity — 

Hyoscine, 489 

Sulphonal, 450 

Thyroid extract, 234 
Insomnia — 

Bromides, 558 

Chloral, 442 

Chloral formamide, 446 

Conium, 528 

Convallaria, 577 

Hyoscine, 489 

Opium, 463 

Paraldehyde, 451 

Phosphorus, 217 

Sulphonal, 528 
Intermittent Fever — 

Ammonium chloride, 643 

Antipyrine, 413 

Arsenic, 260 

Erythrophleum, 663 

Hydrastine, 510 

Ipecac, 638 

Nitric acid, 156 

Phenocoll, 415 

Quinine, 230 

Resorcin, 346 

Salicylic acid, 337 
Intertrigo — 

Bismuth subnitrate, 7S0 

Lead carbonate, 757 

Lycopodium, 810 

Tannic acid, 737 

Zinc carbonate, 762 

Zinc oxide, 761 
Intestinal Catarrh — 

Copaiba, 674 
I, 340 

Turpentine, 670 
Intestinal Dilatation — 

Physostigma, 5 \ 1 
Intestinal Fermentation — 

Oxgall, 701 

Sulphurous acid, 374 



884 



CLINICAL INDEX. 



Intestinal Hemorrhage — 

Alum, 776 

Hematoxylon, 745 

Tannic acid, 737 
Intestinal Obstruction — 

Croton oil, 709 
Intestinal Torpor — 

Picrotoxin, 500 
Intestinal Ulcerations — 

Silver nitrate, 770 
Irido-choroiditis — 

Salicylic acid, 337 
Iritis — 

Calomel, 251 
Irritable Conditions of the Heart — 

Hydrocyanic acid, 548 

Strophanthus, 575 
Irritation, Relief of — 

Cod liver oil, 148 

Jaborandi-poisoning — 

Atropine, 485 
Jaundice — 

Aloes, 700 

Citric acid, 162 

Hydrastine, 510 

Iodoform, 352 

Iris, 705 

Iron, 209 

Manganese sulphate, 212 

Oxgall, 701 

Pilocarpine, 622 

Quinine, 230 

Salol, 340 
Joints, Inflammation of — 

Digitalis, 567 

Rubefacients, 784 
Joints, Tubercular — 

Iodoform, 352 

Keloid— 

Thyroid extract, 233 
Keratitis — 

Gallicine, 740 

Yellow-oxide-of-mercury ointment, 249 
Kidneys, Congestion of — 

Digitalis, 567 

Juniper, 666 

Spirit of nitrous ether, 624 

Laryngeal Catarrh — 

Compound tincture of benzoin, 356 

Turpentine, 670 
Laryngeal Papillomata — 

Chromic acid, 795 
Laryngismus Stridulus — 

Bromides, 559 

Chloral, 442 
Laryngitis — 

Acacia, 807 

Aconite, 605 

Alum, 776 

Ammonium chloride, 643 

Camphor, 406 



Laryngitis — 

Carbolic acid, 327 

Chromic acid, 795 

Glycerin, 803 

Iodine, 270 

Resorcin, 345 

Salol, 340 

Senega, 652 

Subsulphate of mercury, 251 

Succus conii, 527 

Tartar emetic, 634 
Larynx, Chronic Ulceration of- 

Silver nitrate, 770 
Larynx, Congestion of — 

Creosote, 330 
Lead-poisoning — 

Alum, 777 

Croton oil, 710 

Magnesium sulphate, 714 

Sulphuric acid, 157 
Lentigo — 

Tincture of iodine, 270 
Lepra — 

Arsenic, 259 

Phosphorus, 217 
Leucorrhea — 

Alum, 776 

Bismuth subnitrate, 780 

Bismuth tannate, 780 

Boric acid, 365 

Catechu, 742 

Chromic acid, 795 

Cocculus, 500 

Ergot, 506 

Fluid extract of hydrastis, 510 

Geranium, 747 

Glycerite of tannic acid, 803 

Grindelia, 535 

Hematoxylon, 745 

Iron, 209 

Kino, 743 

Krameria, 744 

Lead acetate, 756 

Lime water, 175 

Myrrh, 358 

Potassium permanganate, 367 

Rhus glabra, 748 

Silver nitrate, 770 

Solution of zinc chloride, 799 

Tannic acid, 737 

Tar water, 650 

White oak, 741 

Zinc acetate, 762 

Zinc oxide, 761 

Zinc sulphate, 762 
Leukemia — 

Arsenic, 259 
Lichen — 

Fowler's solution, 259 

Lead acetate, 756 

Sulphuric acid, 157 
Lithemia — 

Alkalies, 176 

Buchu, 664 



CLINICAL INDEX. 



885 



Lithemia — 
Lactic acid, 159 
Nitric acid, 156 
Lithiasis — 

Potassium permanganate, 367 
Liver, Torpor of — 

Podophyllum, 719 
Locomotor Ataxia — 

Acetanilid, 41 1 

Mercury, 250 

Nitroglycerin, 553 

Silver nitrate, 770 
Lumbago — 

Acetanilid, 41 1 

Burgundy-pitch plaster, 784 

Capsicum, 386 

Guaiac, 279 

Salicylic acid, 337 

Turpentine, 669 
Lungs, Chronic Affections of- 

Mercury, 250 
Lungs, Congestion of — 

Digitalis, 570 

Elaterin, 710 
Lungs, Inflammation of — 

Gelsemium, 533 
Lupus — 

Carbolic acid, 327 

Chloride of zinc, 798 

Copaiba, 673 

Hamamelis, 746 

Ichthyol, 347 

Phosphorus, 217 

Pyrogallol, 739 

Salicylic acid, 336 

Tincture of iodine, 270 

Zinc sulphate, 762 
Lymphadenoma — 

Phosphorus, 217 
Lymphangitis — 

Tannic acid, 737 
Lymphatic Enlargements — 

Ichthyol, 347 

Lead iodide, 757 
Lymphoma — 

Arsenic, 259 

Malaria — 

Antipyrine, 413 
Apioline, 733 
Arsenic, 260 
Carbolic acid, 328 
Citric acid, 162 
Eucalyptus, 362 
Hydrastine, 510 
Nuclein, 238 
Pilocarpine, 62 1 
Quinine, 229 
Malarial Fever — 

Ammonium iodide, 272 
Amyl nitrite, 552 
Quinine, 229 
Simple bitters, 191 



Malignant Pustule — 
Iodoform, 352 

Solution of chloride of antimony, 794 
Mammary Glands, Enlarged and 
Painful- 
Olive oil, 805 

Solution of ammonium acetate, 623 
Mania — 

Acetanilid, 411 

Arnica, 615 

Bromoform, 560 

Camphor, 407 

Cannabis, 475 

Conium, 527 

Digitalis, 571 

Ergot, 506 

Gelsemium, 532 

Hydrocyanic acid, 548 

Hyoscine, 489 
Marasmus — 

Bichloride of mercury, 251 

Cod liver oil, 148 
Mastitis — 

Ammonium chloride, 643 

Phytolacca, 61 1 
Measles — 

Mustard bath, 792 
Melancholia — 

Camphor, 407 

Cannabis, 475 

Diluted nitrohydrochloric acid, 156 

Hydrocyanic acid, 548 

Wine of coca, 522 
Meniere's Disease — 

Gelsemium, 533 
Meningitis — 

Calomel, 250 

Cantharides, 789 

Digitalis, 570 

Iodides, 270 
Menopause, Disturbances of — 

Bromides, 559 
Menorrhagia — 

Aloes, 700 

Alum, 776 

Belladonna, 485 

Black haw, 544 

Bromides, 559 

Cannabis, 475 

Conium, 527 

Digitalis, 571 

Ergot, 505 

Gallic acid, 739 

Iron, 209 

Kino, 743 

Savine, 730 

Solution of ammonium acetate, 623 

Tincture of cantharides, ) 

Turpentine, 670 
Menses, to Restore or Increase — 
Emmi and ecbolics, 

Hedeoma, 7.; \ 
Mustard sitz-bath, 792 



886 



CLINICAL INDEX. 



Mercurial Sore Mouth — 

Silver nitrate, 770 
Metritis, Chronic — 

Cannabis, 475 

Ergot, 505 

Tincture of iodine, 270 
Metrorrhagia — 

Geranium, 747 
Migraine — 

Butyl-chloral hydrate, 447 

Caffeine, 585 

Cannabis, 475 

Gelsemium, 533 

Picrotoxin, 500 

Seidlitz powder, 714 

Solution of ammonium acetate, 623 
Mitral Regurgitation — 

Digitalis, 568 
Mitral Stenosis — 

Strophanthus, 575 
Moles — 

Nitric acid, 155 
Morbid Growths — 

Zinc chloride, 798 
Morphine-poisoning — 

Potassium permanganate, 368 

Strychnine, 498 
Mouth, Diseases of — 

Potassium citrate, 174 

Potassium tartrate, 174 
Mouth, Ulcerations of — 

Chromic acid, 795 
Mucous Membranes, Inflamed Con- 
ditions of — 

Demulcents, 801 
Mucous Patches — 

Potassium chlorate, 37 1 
Mumps — 

Pilocarpine, 621 
Muscarine-poisoning — 

Digitalis, 571 

Potassium permanganate, 368 
Myalgia — 

Ammonium chloride, 644 

Salol, 340 

Turpentine, 669 
Myelitis — 

Ergot, 506 

Phenocoll, 415 

Strychnine, 497 
Myocarditis — 

Cactus, 580 

Caffeine, 584 

Diuretin, 679 
Myxedema — 

Thyroid extract, 233 

Narcotic-poisoning — 

Alcohol, 596 
Mustard, 792 
Rubefacients, 783 
Nasal Catarrh — 

Bismuth oxide, 780 
Bismuth subnitrate, 7 80 



Nasal Catarrh — 

Glycerin, 803 

Oil of Scotch fir, 648 
Nasal Polypi — 

Chromic acid, 795 

Nitrate of sanguinarine, 284 

Zinc sulphate, 762 
Nausea — 

Compound spirit of ether, 424 

Hydrochloric acid, 156 

Menthol, 396 

Spirit of nitrous ether, 624 
Neoplasms — 

Cocaine, 521 
Nephritis — 

Amyl nitrate, 552 

Elaterin, 710 

Mercury, 250 

Nitroglycerin, 552 

Potassium bitartrate, 176 

Potassium iodide, 271 

Scoparius, 579 

Terpin hydrate, 654 
Nervous Debility — 

Rubefacients, 783 
Nervous Diseases — 

Cod liver oil, 148 

Iron, 209 
Nervous Excitement — 

Rubefacients, 783 
Nervous Irritability — 

Bromides, 559 
Nervousness — 

Lactucarium, 471 
Neuralgia — 

Acetanilid, 411 

Aconite, 605 

Ammonium chloride, 643 

Arsenic, 260 

Belladonna plaster, 484 

Blisters, 785 

Butyl- chloral hydrate, 447 

Camphor- chloral, 406 

Camphorated chloral, 441 

Cannabis, 475 

Cantharidal blister, 788 

Capsicum, 386 

Chloral, 442 

Colchicum, 275 

Convallaria, 577 

Ether, 424 

Gelsemium, 533 

Hydrocyanic acid, 548 

Hyoscyamus, 489 

Iron, 209 

Oil of cloves, 389 

Phenocoll, 415 

Phosphorus, 216 

Quinine, 230 

Rubefacients, 783 

Salicylic acid, 337 

Strychnine, 497 

Terpin hydrate, 654 

Turpentine, 669 



CLINICAL INDEX. 



887 



Neuralgia — 

Veratrine ointment, 609 
Neurasthenia — 

Alcohol, 597 

Phosphoric acid, 156 

Phosphorus, 216 

Sumbul, 543 
Neuritis — 

Acetanilid, 41 1 

Salol, 340 

Tincture of iodine, 270 
Nevi — 

Chloride of zinc, 798 

Nitric acid, 155 
Night-blindness — 

Strychnine, 497 
Night-sweats — 

Camphoric acid, 407 

Fluid extract of hydrastis, 5 1 1 

Gallic acid, 739 

Geranium, 747 

Lead acetate, 757 

Picrotoxin, 500 

Strychnine, 498 

Zinc oxide, 761 
Nocturnal Emissions — 

Digitalis, 571 
Noma — 

Hydrochloric acid, 154 
Nose, Diseases of — 

Aristol, 352 

Ichthyol, 347 

Iodoform, 352 

Nitric acid, 155 
Nymphomania — 

Bromides, 559 
Nystagmus — 

Physostigmine sulphate, 540 

Obesity — 

Iodothyrin, 233 

Phytolacca, 612 
Offensive Discharges — 

Lead nitrate, 758 
Onychia — 

Lead nitrate, 757 

Tincture of iodine, 270 
Ophthalmia — 

Alum, 776 

Bismuth tannate, 780 

Potassium permanganate, 367 

Silver nitrate, 769 

Zinc sulphate, 762, 763 
Opium Habit — 

Cocaine, 522 
Opium -poisoning — 

Caffeine, 585 

Picrotoxin, 500 
Orchitis — 

Ammonium chloride, 643 

Belladonna ointment, 484 

Hop poultice, 470 

Lead acetate, 756 

Mercurial ointment,. 249 



Orchitis — 

Silver nitrate, 770 
Os Uteri, Rigidity of — 

Ipecac, 638 
Osteitis — 

Hydrochloric acid, 154 
Osteomalacia- 

Phosphorus, 216 
Otitis— 

Antipyrine, 413 

Bismuth subgallate, 780 

Borax, 366 

Cantharidal blister, 789 

Carbolic acid, 327 

Cod liver oil, 149 

Suprarenal extract, 236 

Zinc sulphate, 762 
Otorrhea — 

Boric acid, 365 

Carbolic acid, 327 

Lead acetate, 756 

Salicylic acid, 337 

Silver nitrate, 770 

Tannic acid, 737 
Ovarian Neuralgia — 

Sumbul, 543 
Ovaritis — 

Cantharidal blister, 789 
Oxalic-acid-poisoning — 

Potassium permanganate, 368 
Oxaluria — 

Lactic acid, 159 

Nitric acid, 156 

Zinc sulphate, 762 
Ozena — 

Bismuth oxide, 780 

Bismuth subnitrate, 780 

Camphor, 406 

Camphorated naphthol, 344 

Chromic acid, 795 

Cod liver oil, 149 

Krameria, 744 

Myrrh, 358 

Potassium permanganate, 367 

Quinine, 229 

Saccharin, 682 

Salol, 340 

Solution of chlorinated soda, 377 

Tannic acid, 737 

Pachymeningitis — 

R i iodide-of-mercury ointment, 250 
Pain— 

Ether, 424 

Opium, : 
Palpitation of Heart— 
Aconite, 605 

Compound spirit of ether. 424 
Pannus — 

Yellow-oxide-of-mercury ointm< 
Paralysis — 

alus, 500 

Iodide-, 270 

Rhus toxicodendron, 5 1 ; 



888 



CLINICAL INDEX. 



Paralysis — 

Strychnine, 497 
Paralysis Agitans — 

Cocaine, 522 

Conium, 527 

Gelsemium, 532 

Hyoscine, 489 

Sparteine sulphate, 579 
Paralytic Mydriasis — 

Physostigmine, 540 
Paraplegia — 

Strychnine, 497 
Parasitic Skin Diseases — 

Chlorine water, 376 

Cocculus, 500 

Salicylic acid, 336 

Sulphurous acid, 2HZ 
Paronychia — 

Lead acetate, 756 
Pelvic Cellulitis— 

Mercurial ointment, 249 
Pemphigus — 

Fowler's solution, 259 

Rhus toxicodendron, 513 
Pericarditis — 

Blisters, 785 

Calomel, 251 

Cantharidal blister, 788 

Diuretin, 679 

Iodides, 271 

Squill, 662 
Periodical Fevers — 

Nitric acid, 156 
Periostitis — 

Cantharidal blister, 789 

Iodides, 270 

Tincture of iodine, 270 
Peritonitis — 

Aconite, 605 

Turpentine, 669 
Pernicious Anemia — 

Arsenic, 259 

Phosphorus, 2f6 
Phagedenic Sores — 

Potassium chlorate, 371 

Solution of nitrate of mercury, 250 
Pharyngitis — 

Acacia, 807 

Aconite, 605 

Alcohol, 595 

Alum, 776 

Ammonium chloride, 643 

Antipyrine, 413 

Aromatic spirit of ammonia, 601 

Balsam of tolu, 645 

Borax, 365 

Boric acid, 365 

Calendula, 191 

Camphoric acid, 408 

Capsicum, 386 

Catechu, 742 

Ergot, 505 

Gallic acid, 739 

Glycerin, 803 



Pharyngitis — 

Guaiac, 278 

Hamamehs, 746 

Hedeoma, 734 

Iodine, 270 

Kino, 743 

Krameria, 744 

Myrrh, 358 

Phytolacca, 611 

Potassium bichromate, 369 

Potassium bromide, 558 

Potassium chlorate, 37 1 

Potassium nitrate, 616 

Resorcin, 345 

Rhus glabra, 748 

Sodium benzoate, 357 

Sodium bicarbonate, 175 

Solution of ammonium acetate, 623 

Sulphur, 697 

Sulphurous acid, yiZ 

Tannic acid, 737 

Tincture of hydrastis, 510 

Tincture of iodine, 270 

Xanthoxylum, 286 
Pharynx, Catarrhal Affections of — 

Compound tincture of benzoin, 356 
Phimosis — 

Cocaine, 521 
Phlegmasia Dolens — 

Hamamelis, 746 
Phlyctenular Ophthalmia — 

Yellow-oxide-of-mercury ointment, 249 
Phosphorus-poisoning — 

Magnesium carbonate, 694 

Ozonized oil of turpentine, 670 

Potassium permanganate, 368 
Photophobia — 

Physostigmine, 540 
Phthiriasis — 

Pilocarpine, 622 
Phthisis — 

Acetanilid, 41 1 

Alcohol, 597 

Arsenic, 260 

Benzoic acid, 356 

Codeine, 467 

Creosote, 330 

Gallic acid, 739 

Guaiacol, 333 

Iodine, 270 

Iodoform, 352 

Quinine, 230 

Salicylic acid, t>37 

Sulphurous acid, 373 

Tar, 650 

Terebene, 653 

Thymol, 397 

Wild cherry, 191 
Physostigmine-poisoning — 

Atropine, 485 

vStrychnine, 498 
Pityriasis — 
. Acetic acid, 161 

Aromatic spirit of ammonia, 175 



CLINICAL INDEX. 



889 



Pityriasis — 

Resorcin, 345 
Pleura, Chronic Affections of — 

Mercury, 250 
Pleurisy — 

Aconite, 605 

Blisters, 785 

Burgundy-pitch plaster, 784 

Cantharidal blister, 788 

Gelsemium, 533 

Iodides, 271 

Opium, 464 

Quinine, 230 

Salicylic acid, 338 

Squill, 662 

Tincture of iodine, 270 

Turpentine, 669 
Pleuritic Effusion — 

Caffeine, 584 

Digitalis, 571 

Diuretin, 678 

Pilocarpine, 621 

Salines, 714 
Pneumonia — 

Acetanilid, 41 1 

Aconite, 605 

Alcohol, 596 

Ammonium carbonate, 601 

Ammonium iodide, 271 

Apomorphine, 630 

Arsenic, 261 

Aspidosperma, 542 

Calomel, 251 

Cantharidal blister, 788 

Digitalis, 570 

Grindelia, 535 

Hydrogen dioxide, 372 

Iodides, 271 

Ipecac, 638 

Nitroglycerin, 552 ' 

Potassium nitrate, 617 

Quinine, 230 

Senega, 652 

Serpentaria, 191 

Serum-therapy, 312 

Strychnine, 496 

Turpentine, 670 
Pneumothorax — 

Carbolic acid, 327 
Poisoning — 

Apomorphine, 630 
Poisoning from Noxious Gases — 

Ammonia, 601 
Poisoning from Venomous Reptiles- 
Alcohol, 596 

Ammonia, 601 • 

Calmett's serum, 312 
Polypi — 

Hamamelis, 746 

Zinc chloride, 798 
Polyuria — 

Alum, 776 

Kino, 743 



Portal Congestion— 

Colchicum, 276 
Post-partum Hemorrhage — 

Digitalis, 571 

Ergot, 505 

Ether, 424 

Sodio-benzoate of caffeine, 585 

Strychnine, 498 
Priapism — 

Lupulin, 470 
Prickly Heat- 
Citric acid, 161 
Proctitis — 

Copaiba, 674 
Prolapsus Ani — 

Bismuth subnitrate, 780 

Ergot, 505 

Geranium, 747 

Krameria, 744 

Nitric acid, 155 

Strychnine, 496 

Tannic acid, 737 

White oak, 741 
Prolapsus of Iris — 

Physostigmine, 540 
Prolapsus Uteri — 

Iron, 209 
Prostate Gland, Enlargement of- 

Ergot, 505 
Prostatitis — 

Belladonna, 485 

Hyoscyamus, 489 
Prostatorrhea — 

Iron, 209 

Tincture of cantharides, 789 

Turpentine, 670 
Prurigo — 

Ergot, 506 

Fowler's solution, 259 

Sulphuric acid, 157 

Xeroform, 779 
Pruritus — 

Aconite, 605 

Alum, 776 

Camphorated chloral, 441 

Cannabis, 475 

Carbolic acid, 327 

Ether, 424 

Gallanol, 739 

Gelsemium, 533 

Hydrocyanic acid, 548 

Menthol, 395 

Nitric acid, 155 

Pilocarpine, 622 

Piperazin, 681 

Salicylic arid, | 

Solution of lead subacetat c. 

Tar, 650 

Zinc sulphate, 762 
Pruritus Ani — 

Silver nitrate, 770 
Pruritus Vulvae — 

Silver nitrate, 770 



890 



CLINICAL INDEX. 



Psoriasis — 

Ammonium carbonate, 601 

Arsenic, 259 

Copaiba, 673 

Eucalyptus, 362 

Gallanol, 739 

Lead iodide, 757 

Phosphorus, 217 

Pilocarpine, 622 

Pyrogallol, 739 

Resorcin, 345 

Salicylic acid, 336 

Strophanthus, 575 

Sulphur, 696 

Turpentine, 669 
Ptyalism — 

Alum, 776 

Bismuth subnitrate, 780 

Catechu, 742 

Copper sulphate, 765 

Krameria, 744 

Myrrh, 358 

Pilocarpine, 621 

Potassium chlorate, 371 

Rhus glabra, 748 
Puerperal Eclampsia — 

Amyl nitrite, 552 

Chloral, 442 

Conium, 527 
Puerperal Fever — 

Antistreptococcic serum, 315 

Opium, 464 

Quinine, 230 

Terebene, 653 

Turpentine. 670 
Pulmonary Affections, Chronic — 

Cetraria, 807 

Nuclein, 238 

Turpentine, 670 
Purpura — 

Digitalis, 571 

Ergot, 506 

Sulphuric acid, 157 

Turpentine, 670 
Putrid Sore Throat- 
Potassium permanganate, 367 
Pyelitis- 
Benzoic acid, 357 

Buchu, 664 

Copaiba, 674 

Gallic acid, 739 

Tincture of cantharides, 789 
Pyelo-nephritis — 

Gallic acid, 739 
Pyemia — 

Alcohol, 597 

Iron, 209 

Quinine, 230 
Pyonephrosa — 

Turpentine, 670 
Pyorrhea Alveolaris — 

Hydronaphthol, 344 

Tincture of iodine, 270 



Pyrosis — 

Bismuth subnitrate, 780 
Catechu, 742 
Glycerin, 804 
Kino, 743 
Manganese dioxide, 212 

Rabies — 

Serum-therapy, 319 
Rachitis — 

Cod liver oil, 148 

Phosphorus, 216 

Rectal Bleeding — 

Krameria, 744 

Rectal Fissure — 

Hamamelis, 746 

Rectal Prolapse — 

Nutgall ointment, 740 
Rectal Ulcer- 
Fluid extract of hydrastis, 510 
Hamamelis, 746 
Potassium chlorate, 371 
Silver nitrate, 770 
Tannic acid, 737 
Relaxed Uvula — 
Capsicum, 386 
White oak. 741 
Remittent Fever — 
Gelsemium, 533 
Ipecac, 638 
Iris, 705 
Renal Calculi — 

Piperazin, 681 
Respiratory Organs, Inflamed Condi- 
tions of — 
Althaea, 808 
Restlessness of Fever — 

Convallaria, 580 
Retention of Urine — 

Strychnine, 497 
Rheumatic Affections — 
Rhus toxicodendron, 513 
Rheumatic Arthritis — 

Salicylic acid, 337 
Rheumatic Pains — 
Capsicum, 386 
Turpentine, 669 
Rheumatism — 
Acetanilid, 41 1 
Aconite, 605 
Alkalies, 176 
Ammonium chloride, 644 
Ammonium liniment, 601 
Arnica, 615 
Arsenic, 261 
Asaprol, 343 
Aspidospermine, 543 
Belladonna plaster, 484 
Betol, 343 
Bromides, 559 
Buchu, 664 

Burgundy-pitch plaster, 784 
Camphoric acid, 407 
Citric acid, 162 



CLINICAL INDEX. 



891 



Rheumatism — 

Cod liver oil, 148 

Colchicum, 275 

Guaiac, 279 

Hamamelis, 747 

Mezereon, 285 

Phenacetine, 267 

Phenocoll, 415 

Phytolacca, 611 

Potassium iodide, 271 

Potassium nitrate, 617 

Salicylic acid, 337 

Sanguinaria, 284 

Senega, 652 

Sodium bicarbonate, 175 

Sodium phosphate, 714 

Solution of ammonium acetate, 623 

Sulphur, 697 

Tansy, 732 

Tincture of camphor, 595 

Tincture of iodine, 270 
Rheumatoid Arthritis — 

Alkalies, 176 

Arsenic, 261 

Colchicum, 275 
Rhinitis — 

Nitrate of sanguinarine, 284 
Rhus-poisoning — 

Grindelia, 535 

Hamamelis, 746 

Serpentaria, 192 
Ringworm — 

Acetic acid, 161 

Compound tincture of benzoin, 356 

Copper sulphate, 765 

Salicylic acid, 338 

Salivary Fistula — 

Chromic acid, 795 
Scabies — 

Copper sulphate, 764 

Hyposulphites, 375 

Sulphur ointment, 696 
Scales, Removal of — 

Olive oil, 805 
Scarlatina — 

Belladonna, 484 
Scarlet Fever — 

Antistreptococcic serum, 315 

Digitalis, 570 

Mustard bath, 792 
Sciatica — 

Acetanilid, 411 

Blisters, 785 

Cantharidal blisters, 788 

Colchicine, 275 

Ether, 424 

Nitroglycerin, 553 

Phenocoll, 415 

Potassium iodide, 271 

Salicylic acid, 337 

Sulphur, 697 
Sclerosis — 

Mercury, 250 



Sclerosis — 

Potassium iodide, 271 
Sclerotitis — 

Salicylic acid, 337 
Scrofula — 

Cod liver oil, 148 

Hypophosphites, 220 

Iron iodide, 208 

Phytolacca, 611 

Potassium iodide, 271 

Sarsaparilla, 280 
Scrofulous Glands — 

Zinc chloride, 798 
Scrofulous Sores — 

Conium, 527 

Phosphoric acid, 155 
Scurvy — 

Citric acid, 162 

Sulphuric acid, 157 
Sea-sickness — 

Acetanilid, 411 

Belladonna, 485 

Chloral, 442 

Chloral formamide, 446 

Cocaine, 522 
Seat-worms — 

Quassia, 191 
Sebaceous Cysts — 

Ether, 424 
Seborrhea— 

Hamamelis, 746 

Hydrastine ointment, 510 

Resorcin, 345 
Seminal Emissions — 

Iron, 209 
Senile Debility — 

Spermine, 232 
Senile Gangrene — 

Camphor, 407 
Septicemia — 

Alcohol, 597 

Antistreptococcic serum, 315 

Colloidal silver, 772 

Iron, 209 

Quinine, 230 

Serum-therapy, 315 
Sequestra — 

Hydrochloric acid, 154 
Sexual Excitement — 

Monobromated camphor, 407 
Shock- 
Digitalis, 570 

Ether, 424 

( )pium, 464 
Skin, Diseases of — 

Acetic acid, 161 

Argentol, 771 
Aristol, 352 

Cod liver oil, 14S 

Eucalyptus, 362 

I [ydrochloric acid, 156 

Iodoform, 

Liquor potass .171 

assium carbonate, 1 74 



8 9 2 



CLINICAL INDEX. 



Skin, Diseases of — 

Sulphuric acid, 157 
Skin, Irritable and Inflamed Condi- 
tions of — 

Althea, 808 
Small-pox — 

Alcohol, 596 
Sore Nipples — 

Silver nitrate, 770 

Tannic acid, 737 
Sore Throat — 

Acetic acid, 161 

Alum, 776 

Hydrochloric acid, 154 

Liquorice, 647 
Sores, Foul-smelling — 

Hematoxylon, 745 
Spasmodic Rigidity of Os Uteri — 

Belladonna ointment, 484 

Chloral, 442 
Spasms, Habit — 

Conium, 527 
Spermatorrhea — 

Belladonna, 485 

Bromides, 559 

Camphoric acid, 407 

Digitalis, 571 

Ergot, 506 

Gelsemium, 533 

Lupulin, 470 

Strychnine, 498 

Tincture of cantharides, 789 

Turpentine, 670 
Spinal Congestion — 

Belladonna, 485 

Ergot, 506 
Spinal Diseases — 

Acetanilid, 411 
Spinal Meningitis — 

Blisters, 785 
Splenic Enlargements — 

Ergot, 506 

Lead iodide, 757 

Red-iodide-of-mercury ointment, 250 
Spongy Gums — 

Catechu, 742 

Krameria, 744 

Myrrh, 358 

Rhus glabra, 748 

Tannic acid, 737 

Tincture of benzoin, 357 
Sprains — 

Alcohol, 595 

Arnica, 615 

Calendula, 191 

Camphor liniment, 406 

Hamamelis, 746 

Olive oil, 805 

Rhus toxicodendron, 513 

Solution of lead subacetate, 757 

Tansy, 732 
Sthenic Fevers — 

Chloral, 443 



Stomatitis — 

Alum, 776 

Bismuth subnitrate, 780 

Chlorine water, 376 

Copper sulphate, 765 

Geranium, 747 

Salicylic acid, 337 

Tannic acid, 737 

Thymol, 397 

Zinc sulphate, 762 
Strabismus — 

Bromides, 559 
Strangury — 

Demulcents, 801 

Onion poultice, 646 
Stricture — 

Aconite, 605 

Olive oil, 805 

Suprarenal extract, 236 
Strychnine-poisoning — 

Amyl nitrite, 552 

Bromides, 559 

Chloral, 442 

Potassium permanganate, 368 
Subinvolution — 

Cannabis, 475 

Ergot, 505 

Glycerite of tannic acid, 803 
Sweating — 

Alcohol, 595 

Alum, 776 

Belladonna, 484 

Bismuth subnitrate, 780 

Camphoric acid, 407 

Ergot, 506 

Gallic acid, 739 

Hematoxylon, 745 

Kino, 743 

Lead oxide, 757 

Pilocarpine, 621 

Silver oxide, 770 

Sulphuric acid, 157 

Zinc oxide, 761 
Swellings, Glandular — 

Tincture of iodine, 270 
Swellings, Inflammatory — 

Ammonium chloride, 643 
Sycosis — 

Hyposulphites, 369 

Phytolacca, 611 

Resorcin, 345 

Salicylic acid, 336 

Salol, 340 

Sulphur, 696 

Tannic acid, 737 
Sympathetic Cough — 

Asafetida, 407 
Syncope — 

Alcohol, 596 

Mustard, 792 
Synovitis — 

Belladonna ointment, 483 

Cantharidal blister, 789 

Ichthyol, 347 



CLINICAL INDEX. 



*93 



Synovitis — 

Iodoform, 352 

Lead acetate, 756 

Mercurial ointment, 2 J, 9 

Tincture of iodine, 270 

Vesicants, 785 
Syphilis — 

Arsenic, 261 

Bromides, 560 

Chloride of zinc, 798 

Chromic acid, 795 

Cod liver oil, 148 

Guaiac, 278 

Iodides, 270 

Iodoform, 352 

Iron iodide, 208 

Mercurial preparations, 249 

Mezereon, 285 

Nitric acid, 156 

Papain, 144 

Phytolacca, 611 

Sarsaparilla, 280 

vSe rum -therapy, 316 

Silver iodide, 770 

Thyroid extract, 235 

Tabes Dorsalis — 

Acetanilid, 411 
Tape- worms — 

Carbolic acid, 328 

Ether, 424 

Kousso, 725 

Male fern, 724 

Pomegranate, 726 

Pumpkin seed, 727 

Salicylic acid, 338 
Tetanus — 

Acetanilid, 411 

Amyl nitrite, 552 

Bromides, 559 

Chloral, 442 

Conium, 527 

Curare, 530 

Gelsemium, 532 

Opium, 463 

Physostigma, 541 

Salicylic acid, 337 

Serum-therapy, 299 
Thirst, to Quench — 

Demulcents, 801 
Thread-worms — 

Rhubarb, 703 
Throat, Acute Inflammation of- 

Tartar emetic, 633 
Throat, Diseases of — 

Aristol, 352 

Iodoform, 352 

Liquor potassse, 174 

Nitric acid, 155 

Pilocarpine, 621 
Throat, Relaxed— 

Myrrh, 358 

Sodium sulphocarbolate, 329 



Thrombosis — 
Ammonia, 602 
Thrush- 
Sodium bicarbonate, 175 

Sodium sulphocarbolate, 329 
Thyroid Gland, Enlargement of- 

Iris, 705 
Tic Douloureux — 

Aconite, 605 

Butyl-chloral hydrate, 447 

Veratrine ointment, 610 
Tics— 

Conium, 527 
Tinea Capitis — 

Carbolic acid, 327 
Tinea Circinata — 

Cantharidal blister, 789 

Carbolic acid, 327 
Tinea Sycosis — 

Copper sulphate, 765 
Tinea Tarsi- 
Copper sulphate, 765 
Tinea Tonsurans — 

Cantharidal blister, 789 

Carbolic acid, 327 

Hydronaphtol, 344 

Tincture of iodine, 270 

Turpentine, 669 
Tinea Versicolor — 

Sulphur ointment, 696 
Tinnitus — 

Suprarenal extract, 236 
Toadstool-poisoning — 

Atropine, 485 
Tobacco Habit — 

Cocaine, 522 

Strophantus, 575 
Tongue, Fissure of — 

Glycerin, 803 
Tongue, Tuberculosis — 

Chromic acid, 795 
Tonsillitis — 

Aconite, 605 

Alum, 776 

Camphorated naphtol, 343 

Gallic acid, 739 

Guaiac, 278 

Guaiacol, 333 

Phytolacca, 611 

Quinine, 229 

Rhus glabra. 748 

Salicylic acid, 337 

Silver nitrate, 770 

■iin bicarbonate, \~^ 
liuno sulphocarbolate, 329 

Tanm 
Tonsils, Enlarged — 

Zinc iodidi 

Zinc sulphate, 762 
Toothache — 

( lampho-phenique, 327 

( kmpborated chloral, 441 

( !apsicum, .> s <> 

( xeosote, 330 



8 94 



CLINICAL INDEX. 



Toothache — 

Oil of cloves, 389 
Torticollis — 

Capsicum, 386 

Conium, 527 
Trachea, Congestion of — 

Creosote, 330 
Tracheitis — 

Ipecac, 637 

Silver nitrate, 770 

Terpin hydrate, 654 
Trachoma — 

Alum, 776 

Bismuth subnitrate, 780 
Trichophytosis — 

Gallanol, 739 
Tubercular Joints — 

Iodoform, 352 
Tuberculosis — 

Benzoyl-eugenol, 389 

Bone-marrow, 238 

Camphorated naphthol, 343 

Cantharidin, 789 

Cod liver oil, 148 

Creosote, 330 

Guaiacol, 333 

Hydronaphtol, 344 

Hypophosphites, 220 

Iron, 209 

Nuclein, 238 

Phosphoric acid, 155 

Serum-therapy, 309 
Tuberculous Ulceration — 

Calcium phosphate, 220 

Lactic acid, 158 
Turgescence of Nasal Mucous Mem- 
brane — 

Cubeb, 676 
Tylosis — 

Salicylic acid, 336 
Tympanites — 

Asafetida, 407 

Turpentine, 670 
Typhoid Fever — 

Acacia, 807 

Alcohol, 596 

Bismuth salicylate, 780 

Camphor, 407 

Carbolic acid, 328 

Chlorine water, 376 

Digitalis, 570 

Eucalyptus, 362 

Hydrochloric acid, 155 

Hydronaphtol, 344 

Hyposulphites, 375 

Nuclein, 238 

Oxgall, 701 

Potassium chlorate, 371 

Quinine, 230 

Salicylic acid, 337 

Serum-therapy, 316 

Serpentaria, 192 

Sodium sulphocarbolate, 329 

Strychnine, 496 



Typhoid Fever — 

Thymol, 397 
Turpentine, 670 
Zinc sulphate, 762 
Typhus Fever — 
Alcohol, 596 
Camphor, 407 
Serpentaria, 192 

Ulcerated Nipples — 

Catechu, 742 
Ulceration, Phagedenic — 

Nitric acid, 155 
Ulcerations, Superficial — 

Castor oil, 692 
Ulcer of Cervix — 

Carbolic acid, 327 
Ulcer of Stomach — 

Pepsin, 142 
Resorcin, 346 
Ulcerous Gums- — 

Tannic acid, 737 
Ulcers — 
Alcohol, 595 
Alum, 776 
Alumnol, 343 
Aristol, 352 
Bismuth benzoate, 357 
Bismuth subgallate, 780 
Bismuth subiodide, 781 
Bismuth subnitrate, 780 
Camphor ointment, 406 
Cantharidal blister, 788 
Carbolic acid, 327 
Catechu, 742 
Chloral, 441 
Chloride of zinc, 798 
Chromic acid, 795 
Copaiba, 673 
Copper sulphate, 765 
Fluid extract of hydrastis, 510 
Galla, 740 
Grindelia, 535 
Hydrogen dioxide, 372 
Iodoform, 352 
Iron sulphate, 208 
Kino, 743 
Lycopodium, 810 
Nuclein, 238 
Phytolacca, 61 r 
Potassium bromide, 558 
Potassium chlorate, 371 
Potassium permanganate, 367 
Resorcin, 345 
Rhus glabra, 748 
Silver nitrate, 770 
Solution of chlorinated soda, 377 
Tannic acid, 737 
Tar, 650 
Terebene, 653 
Vesicants, 785 
White oak, 741 
Zinc oxide, 761 
Zinc sulphate, 762 



CLINICAL INDEX. 



895 



Ulcers of Mouth and Throat — 

Tincture of hydrastis, 510 
Ulcers, Syphilitic — 

Carbolic acid, 327 

Potassium permanganate, 366 

Resorcin, 345 
Ulcers, Venereal — 

Calomel, 249 
Uremia — 

Opium, 463 

Pilocarpine, 621 
Uremic Convulsions — 

Chloral, 442 
Urethral Caruncles — 

Cocaine, 520 
Urethritis — 

Buchu, 664 

Elm, 808 
Uric-Acid Diathesis — 

Lithium bromide, 559 

Lithium preparations, 177 
Urinary Organs, Inflamed Conditions 
of— 

Althea, 808 
Urticaria — 

Alcohol, 595 

Anderson's powder, 406 

Citric acid, 1 61 

Copaiba, 674 

Ergot, 506 

Ether, 424 

Hamamelis, 746 

Hydrocyanic acid, 548 

Menthol, 395 

Solution of lead subacetate, 757 
Uterine Cancer — 

Conium, 527 

Iodoform, 352 

Terebene, 653 
Uterine Contraction, to Stimulate — 

Quinine, 230 
Uterine Fibroids — 

Ergot, 505 
Uterine Hemorrhage — 

Alcohol, 595 

Cinnamon, 382 

Ergot, 505 

Hydrastine, 510 

Ipecac, 637 

Krameria, 744 

Nitric acid, 155 

Senegin, 652 

Sulphuric acid, 157 

White oak, 741 
Uterine Polypi — 

Ergot, 505 
Uterine Tumors — 

Cotton-root bark, 507 
Uterine Ulcerations — 

Fluid extract of hydrastis, 510 

Iodoform, 352 
Uterus, Congestion of — 

Glycerite of tannic acid, 803 



Uterus, to Dilate Neck of — 

Elm, 808 
Uvula, Relaxation of — 

Alum, 776 

Catechu, 742 

Kino, 743 

Krameria, 744 

Vaginal Ulcerations — 

Fluid extract of hydrastis, 510 
Vaginitis — 

Ammonium chloride, 643 

Copaiba, 674 

Grindelia, 535 
Vaginitis — 

Lime water, 175 
Valvular Diseases of Heart — 

Convallaria, 577 

Digitalis, 56S 

Sparteine sulphate, 579 

Strophanthus, 575 
Varicocele — 

Ergot, 505 
Varicose Ulcers — 

Hamamelis, 746 
Varicose Veins — 

Ergot, 505 
Variola — 

Glycerine of starch, 803 
Venereal Sores — 

Black wash, 175 

Hydrogen dioxide, 372 

Salol, 340 

Solution of nitrate of mercury, 250 

Yellow wash, 175 
Venereal Warts — 

Nitric acid, 155 
Verruca — 

Alum, 775 

Salicylic acid, 336 
Vertigo — 

Suprarenal extract, 236 

Valerian, 40S 
Vesical Calculi — 

Pipera/.in, 681 
Vesical Catarrh- 
Silver nitrate, 770 

Tar water, 650 

Thymol, 397 
Vesical Tenesmus — 

Hyoscyamus, 489 
Vomiting — 

Ammonium bromide, 559 

Bismuth subnitrate, 780 

Caffeine, 585 

( lalomel, 

Cantharidal blister, 789 

( Ihampagn 

I !< icainej - 

i ;in\ powder, -50 

I I ydrochloric acid, 15" 
Hydrocyanic acid, 548 
[Decac, <>37 

Lime water, 176 



896 



CLINICAL INDEX. 



Vomiting — 
Menthol, 396 
Quinine, 230 

Vomiting of Pregnancy — 
Ammonium bromide, 559 
Cerium oxalate, 781 
Chloral, 442 
Strychnine, 496 
Tincture of iodine, 272 

Vomiting of Uterine Disease- 
Cerium oxalate, 781 

Vulvitis — 

Zinc sulphate, 762 

Warts — 

Acetic acid, 161 

Arsenic, 258 

Glacial acetic acid, 797 

Potassium bichromate, 369 

Salicylic acid, 336 
Wasting Diseases — 

Cod liver oil, 148 

Phosphoric acid, 1 56 
Whooping Cough — 

Acetanilid, 41 1 

Alum, 776 

Ammonium chloride, 643 

Antipyrin, 413 

Asafetida, 407 

Belladonna, 484 

Bromides, 559 

Bromoform, 560 

Caffeine, 584 

Chloral, 442 

Cod liver oil, 148 

Coffee, 584 

Ergot, 506 

Gelsemium, 532 

Grindelia, 535 

Hydrocyanic acid, 548 



Whooping Cough — 

Hyoscyamus, 489 

Ouabain, 575 

Quinine, 230 

Resorcin, 346 

Silver nitrate, 770 

Syrup of garlic, 646 

Tannic acid, 737 

Terebene, 653 

Zinc oxide, 762 

Zinc sulphate, 762 
Worms — 

Anthelmintics, 719 

Chenopodium, 721 

Kamala, 727 

Olive oil, 805 

Santonin, 722 

Spigelia, 723 
Wounds — 

Alcohol, 595 

Bismuth subgallate, 778 

Bismuth subnitrate, 778 

Campho-phenique, 406 

Chlorine water, 376 

Compound tincture of benzoin, 356 

Glycerin, 803 

Iodoform, 352 

Olive oil, 805 

Resorcin, 345 

Rhus glabra, 748 

Salol, 340 

Silver nitrate, 770 

Sulphurous acid, 373 

Terebene, 653 

Turpentine, 669 

Yellow Fever — 

Hyposulphites, 375 
Turpentine, 670 



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For Practitioners and Students. A Complete Dictionary of the Terms 
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The American Pocket Medical Dictionary. ™™° n ' 

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19 



NOTHNAGEL'S ENCYCLOPEDIA 

OF 

PRACTICAL MEDICINE 

AMERICAN EDITION 

Edited by ALFRED STENGEL, M. D. 

Professor of Clinical Medicine in the University of Pennsylvania ; Visiting 
Physician to the Pennsylvania Hospital 

IT is universally acknowledged that the Germans lead the world in Internal 
Medicine ; and of all the German works on this subject, Nothnagel's " Speci- 
. elle Pathologie und Therapie" is conceded by scholars to be without question 
the best System of Medicine in existence. So necessary is this book in the study 
of Internal Medicine that it comes largely to this country in the original German. 
In view of these facts, Messrs. W. B. Saunders & Company have arranged with 
the publishers to issue at once an authorized American edition of this great ency- 
clopedia of medicine. 

For the present a set of ten volumes, representing the most practical part 
of this excellent encyclopedia, and selected with especial thought of the needs 
of the practical physician, will be published. These volumes will contain the 
real essence of the entire work, and the purchaser will therefore obtain at less 
than half the cost the cream of the original. Later the special and more strictly 
scientific volumes will be offered from time to time. 

The work will be translated by men possessing thorough knowledge of both 
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very latest views of the leading' American and English specialists in the various 
departments of Internal Medicine. The whole System will be under the edi- 
torial supervision of Dr. Alfred Steng'el, who will select the subjects for the 
American edition, and arrange for the editing of the different volumes. 

Unlike most encyclopedias, the publication of this work will not be extended 
over a number of years, but five or six volumes will be issued during the coming 
year, and the remainder of the series at the same rate. Moreover, each volume 
will be revised to the date of its publication by the eminent editor. This will 
obviate the objection that has heretofore existed to systems published in a number 
of volumes, since the subscriber will receive the completed work while the earlier 
volumes are still fresh. 

The usual method of publishers, when issuing a work of this kind, has been 
to compel physicians to take the entire System. This seems to us in many cases 
to be undesirable. Therefore, in purchasing this encyclopedia, physicians will be 
given the opportunity of subscribing for the entire System at one time ; but any 
single volume or any number of volumes may be obtained by those who do not 
desire the complete series. This latter method, while not so profitable to the pub- 
lisher, offers to the purchaser many advantages which will be appreciated by those 
who do not care to subscribe for the entire work at one time. 

This American edition of Nothnagel's Encyclopedia will, without question, 
form the greatest System of Medicine ever produced, and the publishers are con- 
fident that it will meet with general favor in the medical profession. 

20 



NOTHNAGELS 
ENCYCLOPEDIA OF PRACTICAL MEDICINE. 

AMERICAN EDITION. 

VOLUMES JUST ISSUED AND IN PRESS. 

TYPHOID AND TYPHUS FEVERS. By Dr. II. Gurschmann, of Leipsic. 
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SIPELAS and ERYSIPELOID. By Dr. II. Lenhartz, of Hamburg. PER- 
TUSSIS and HAY-FEVER. By Dr. G. Sticker, of Giess 
Editor, Sir J. W. Moore, B.A., M.D., F.R.C.P.I., Professor of the Practice of Medi 
cine, Royal College of Surgeons, Ireland. Handsome octavo • I I 82 1 ag< . ill - 
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DIPHTHERIA. An original article by William P. Northrup, M.D., of New York. 
Measles, Scarlet Fever, Rotheln. By Dr. Th. von JtfRGENS] s. « ; Tubingen. 
Editor, William P. Northrup, M. D., Professor of Pediatrics, University and B< 

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page plates, 3 in colors. Cloth, $5x0 net; Half Morocco, :>o.oo net Ju t . 

DISEASES OF THE BRONCHI. By Dr. F. A. Hoffmann, of Leipsic. DIS- 
EASES OF THE PLEURA. By Dr. O. Rosenuaum, of Berlin. PNEUMONIA. 
By Dr. E. Aufrecht, of Magdeburg. 
Editor, John H. Musser, M. D., Professor of Clinical Medicine, University of Pi 

vania. Handsome octavo, 700 pages, 7 full-page lithographs in colors. Cloth, 
net ; Half Morocco, $6.00 net. just Ready. 

DISEASES OF THE LIVER. By Drs. H. Qutncki and G. Hoppe-Seyler, of 1 

DISEASES OF THE PANCREAS. By Dr. L. < >ser, of Vienna. DISEASES 

OFTHE SUPRARENALS. By Dr. E. Xkism-.r. of Vienna. 
Editors, Frederick A. Packard, M.D., Physician to the Penna. and the Children- 
Hospitals, Phila. ; and Reginald H. Fitz, A. M., M. D.. Hersey Prof, of the Theory 

and Practice of Physic. Harvard Univ. Handsome octavo of 750 page.-, illustrated. 
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INFLUENZA AND DENGUE. By Dr. O. Leichtenstern, ol MALA- 

RIAL DISEASES. By Dr. I. Mannaberg, ol Vienna. 
Editor, Ronald Ross, F.R.C.S., Eng., D.P.H., F.R.S., Major, Indian Medical 

Service, retired; Walter Myers, Lecturer, Liverpool School ol Ti licine, 

Liverpool. Handsome octavo, 700 pages, 7 full-page lithographs in colors. 

ANEMIA, LEUKEMIA, PSEUDOLEUKEMIA, HEMOGLOBINEMIA. Bj Dr. P. 

Ehrlich, of Frankfort-on -the- Main, Dr. a. Lazarus, ol < ha lottenburg, a d Dr. 
Felix Pinkus, of Berlin. CHLOROSIS. By Dr. K. VOW Noorden, of Frank- 

fort-on-the-Main. 

Editor, Alfred Stengel, M.D., Professor of Clinical Medicine. University of P 

vania. Handsome octavo, 750 pages, 5 full-page lithographs in c< '• 

TUBERCULOSIS AND ACUTE GENERAL MILIARY TUBERCULOSIS. By 

Dr. G. Cornet, of Berlin. 

Editor to be announced later. Handsome octavo, 700 pages. 

DISEASES OF THE STOMACH. By Dr. F. Km 

Editor, Charles G. Stockton, M.D., Professor of Medicine, In 

Handsome octavo, 800 pages, with 29 text-cuts and 6 full p 

DISEASES OF THE INTESTINES AND PERITONEUM. By Ik HERMANN 

Nothnagel, of Vienna. 

Editor, Humphry D. Rolleston, M.D., F.R.C.P.. Physician to and 1 
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21 



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W. B. SAUNDERS & COMPANY 



ANATOMY, EMBRYOLOGY, 

HISTOLOGY. 

B ohm, Davidoff, and Huber— Histology, . 4 

Clarkson— A Text-Book of Histology, . . 5 

Haynes— A Manual of Anatomy, .... 8 

Heisler — A Text-Book of Embryology, . . '8 

Leroy— Essentials of Histology, 16 

McClellan — Art Anatomy 10 

McClellan — Regional Anatomy, 10 

Nancrede — Essentials of Anatomy 16 

Nancrede — Essentials of Anatomy and 

Manual of Practical Dissection 11 

SobOtta — Atlas of Normal Histology, . . 19 

BACTERIOLOGY. 

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Frothingham — Laboratory Guide, .... 7 
Gorham — Laboratory Bacteriology, ... 7 
Lehmann and Neumann — Atlas of Bacte- 
riology 19 

Levy and Klemperer's Clinical Bacteri- 
ology, 10 

Mallory and Wright— Pathological Tech- 
nique 10 

McFarland — Pathogenic Bacteria 11 

CHARTS, DIET-LISTS, ETC 

Griffith— Infant's Weight Chart 8 

Keen — Operation Blank, 9 

Laine — Temperature Chart 10 

Meigs — Feeding in Early Infancy 11 

Starr — Diets for Infants and Children, . . 13 

Thomas — Diet-Lists 14 

CHEMISTRY AND PHYSICS. 

Brockway — Essentials of Medical Physics, 16 

JellifTe and Diekman — Chemistry, ... 9 

Wolf — Urine Examination 15 

Wolff— Essentials of Medical Chemistry, . 16 

CHILDREN. 

American Text-Book Dis. of Children, . . 1 

Griffith— Care of the Babv 8 

Griffith— Infant's Weight Chart, 8 

Meigs — Feeding in Early Infancy, .... n 

Powell — Essentials of Diseases of Children, 16 

Starr — Diets for Infants and Children, . . 13 

DIAGNOSIS. 
Cohen and Eshner — Essentials of Diag- 
nosis 16 

Corwin — Physical Diagnosis, 5 

Vierordt — Medical Diagnosis, 15 

DICTIONARIES. 

The American Illustrated Medical Dic- 
tionary, 3 

The American Pocket Medical Dictionary, 3 

Morten — Nurses' Dictionary n 



EYE, EAR, NOSE, AND THROAT. 

An American Text-Book of Diseases of 

the Eve, Ear, Nose, and Throat 1 

Briihl and Politzer— Atlas of otology, . 19 
BeSchweinitz— Diseases of the Eye, . . 6 
Friedrich and Curtis — Rhinology, Laryn- 
gology and Otology 7 

Gleason — Essentials of Diseases of the Ear, 16 

Gleason — Ess. of Dis. of Nose and Throat, 16 

Gradle — Ear, Nose, and Throat 7 

Grant — Surgery of Face, Mouth , and Jaws, 8 
Grlinwald — Atlas of Mouth, Throat, and 

Nose, ,. 19 

Grlinwald— Atlas of Diseases of the 

Larynx, 17 

Haab — Atlas of External Diseases of the 

Eye 17 

Haab — Atlas of Ophthalmoscopy 18 

Jackson — Manual of Diseases of the Eye, 9 

Jackson — Essentials of Diseases of Eye, 16 

Kyle— Diseases of the Nose and Throat, . 9 



GENITO-URINARY. 

An American Text-Book of Genito-Uri 

nary and Skin Diseases 

Hyde and Montgomery— Syphilis and the 
Venereal Diseases ■ 

Martin — Essentials of Minor Surgery 
Bandaging, and Venereal Diseases, . 

Mracek— Atlas of Syphilis and the Vene- 
real Diseases 

Saundby — Renal and Urinary Diseases, . 

Senn — Genito-Urinary Tuberculosis, . . 

Vecki — Sexual Impotence 



GYNECOLOGY. 

American Text-Book of Gynecology 
Cragin — Essentials of Gynecology, . 
Garrigues — Diseases of Women, . 
Long — Syllabus of Gynecology, . . 
Penrose — Diseases ofWomen, . . . 
Schaeffer— Atlas of Operative Gynecology 
Schaeffer — Atlas of Gynecology 18 

HYGIENE. 
Abbott — Hygiene of Transmissible Diseases 4 

Bergey — Principles of Hygiene, 4 

Pyle — Personal Hygiene, 12 

MATERIA MEDICA, PHARMACOL- 
OGY, AND THERAPEUTICS. 

American Text-Book of Therapeutics, . 
Butler— Text-Book of Materia Medica 

Therapeutics, and Pharmacology, . . 
Morris — Ess. of M. M. and Therapeutics 
Saunders' Pocket Medical Formulary, . 

Sayre — Essentials of Pharmacy 

Sollmann— Text- Book of Pharmacology, 
Stevens — Manual of Therapeutics, . . 
Stoney— Materia Medica for Nurses, . 
Thornton — Prescription-Writing, . . . 



5 

16 
12 
16 
13 
14 
14 
15 



MEDICAL PUBLICATIONS OF W. B. SAC/NDLA'S 









MEDICAL JURISPRUDENCE AND 
TOXICOLOGY. 

Chapman — Medical Jurisprudence and 

Toxicology, 5 

Crothers — Morphinism 6 

Golebiewski — Atlas of Diseases Caused by 

Accidents, iS 

Hofmann— Atlas of Legal Medicine, ... 17 

NERVOUS AND MENTAL 
DISEASES, ETC. 

Brower — Manual of Insanity 5 

Chapin — Compendium of Insanity, ... 5 
Church and Peterson — Nervous and Men- 
tal Diseases 5 

Jakob — Atlas of Nervous System, . . . 18 
Shaw — Essentials of Nervous Diseases and 

Insanity 16 

NURSING. 

Davis — Obstetric and Gvnecologic Nursing, 6 

Griffith— The Care of the Baby 8 

Meigs— Feeding in Early Infancy, .... 11 | 

Morten — Nurses' Dictionary 11 ; 

Stoney — Materia Medica for Nurses, . . 14 j 

Stoney— Practical Points in Nursing, . . 14 

Stoney — Surgical Technic for Nurses, . . 14 

Watson— Handbook for Nurses 15 j 

OBSTETRICS. 

An American Text-Book of Obstetrics, . 2 | 

Ashton— Essentials of Obstetrics, .... 16 

Boisliniere— Obstetric Accidents 4 

Dorland— Modern Obstetrics 6 

Hirst— Text-Book of Obstetrics 8 

Norris — Syllabus of Obstetrics 11 

Schaeffer — Atlas of Labor and Operative 

Obstetrics . . 18 

Schaeffer — Atlas of Obstetrical Diagnosis 

and Treatment, 18 

PATHOLOGY. 
An American Text-Book of Pathology, . 2 
Diirck — Atlas of Pathologic Histology, . . 17 
Kalteyer — Essentials of Pathology, ... 16 
Mallory and Wright— Pathological Tech- 
nique, 10 

Senn — Pathology and Surgical Treatment 

of Tumors, 13 

Stengel — Text-Book of Pathology, . . 14 

Stengel and White— Blood 14 

Warren— Surgical Pathology and Thera- 
peutics, 15 

PHYSIOLOGY. 

An American Text-Book of Physiology, 2 

Budgett— Essentials of Physiology, ... 16 

Raymond — Human Physiology 12 

Stewart — Manual of Physiology 14 

PRACTICE OF MEDICINE. 

An American Year-Book <>f Med. & Surg., 9 



An American Text-Book of Tin o.\ Prac, 3 

Anders — Practice of Medicine 4 

Eichhorst — Practice of Medicine 6 

Lockwood — Manual of the Practice of 

Medicine, to 

Morris — Ess. of Practice of Medicine, . . 16 

Nothnagel's Encyclopedia 20, 21 

Salinger and Kalteyer— Mod. Medicine, 12 

Stevens — Manual of Practice of Medicine, 14 



SKIN AND VENEREAL. 

An American Text-Book ol Genito- 
urinary and Skin Diseases 2 

Hyde and Montgomery— Syphilis and the 

Venereal 1 tiseast - 8 

Martin — Essentials of M ery, 

Bandaging, and Venereal 1 1 

Mracek— Atlas of Diseases of the Skin, . 17 

Stelwagon — Diseases of Skin 13 

Stelwagon- Ess. of Diseases of the Skin, 16 

SURGERY. 

An American Text-Book of Surg.-ry, . . 2 
An American Year-Book ol Medicine and 

Surgery 3 

Beck — Fractures 4 

Beck — Manual of Surgical Asepsis, ... 4 

DaCosta — Manual of Surgery 6 

Helferich — Atlas of Fractures 19 

International Text-Book ol Surgery, . . 9 

Keen— Operation Blank 9 

Keen— The Surgical Complications and 

Sequels of Typhoid Fever 9 

Macdonald — Surgical Diagnosis and Treat- 
ment 10 

Martin — Essentials of Minor Surgery, 

Bandaging, and Venereal Diseases, . . 16 

Martin— Essentials of Surgery 16 

Moore— Orthopedic Surgery 11 

Nancrede — Principles of Surgery 11 

Pye — -Bandaging and Surgical Dressing, . 12 

Scudder— Treatment of Fractures, ... 13 

Senn— Genito-Urinary Tuberculosis, . . . 13 

Senn — Practical Surgery 13 

Senn — Syllabus of Surgery 13 

Senn — Tumors 13 

Sultan — Atlas of Abdominal Hernia. . . 19 
Warren — Surgical Pathology and Thera- 
peutics IS 

Zuckerkandl — Atlas of Operatise Surgery, 17 

URINE AND URINARY DISEASES. 

Ogden — Clinical Examination of the Urine, 11 

Saundby — Renal and Urinar) Diseases, . 12 

Wolf — Urine Examination 15 

Wolff— Essentials of Examination of Urine, 16 

MISCELLANEOUS. 

Bastin — Laboratory Exercises in I | 

Galbraith— Four Epochs of Woman's 

Life 7 

Golebiewski -Atlas ol Diseases caused 

by Accidents 18 

Gould and Pyle — Anomalies and Curiosi- 
ties of Medicine 7 

Grafstrom— Massage 8 

Keating— Examination for Life Insurant 
Robson and Moynihan -D the 

Pancreas 12 

Saunders' Medical Hand-Atlases, . 17, 18. 19 

Saunders' Pocket Medical Formulary. tfl 

Saunders' Question-Compends 16 

Stewart and Lawrance — Essentia) 

Medical Electricity 16 

Thornton -Dose-Book and Manual 

Prescription-Writing, 15 

Warwick and Tunstall 1 the 

Injured and Sick 15 



